#LivingLibrary – College of Psychiatrists of Ireland event for #GreenRibbon month, 31st May 2018

I will be speaking as a living book in this:
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The College is delighted to announce our 4th annual event in partnership with See Change for Green Ribbon Month – A Living Library
When it comes to mental health everyone has a story to share and we find comfort, empathy and compassion in shared experiences. Social contact is known to be one of the most effective ways of reducing mental health related stigma and discrimination so with this in mind, and to mark Green Ribbon month, the College is delighted to announce our ‘Living Library’ event, a library come to life in the outdoors!

At our library the ‘books’ are a little different, they are people; people with different experiences and stories to tell related to mental health including those who have experienced mental health issues and illness, their family members and carers, and the psychiatrists who help them towards the path of recovery. Mental health stigma too often creates discrimination and misunderstanding so we want to give members of the public the opportunity to connect and engage with psychiatrists and people they may not normally have the occasion to speak with.

The aim is to better understand the lived experiences of others who have experienced or facilitated recovery from mental illness and distress and to challenge their own assumptions, prejudices and stereotypes. We invite you to ‘read’ the human books through conversation and gain understanding of their experiences.

For Green Ribbon Month Let’s End the Stigma by not judging a book by its cover and develop a greater understanding of each other’s stories.

Thursday 31st May 2018
12.30pm – 2.30pm
St Stephens Green, Dublin

This is a Free Event, but space is limited. Book your place here.

DUBLIN 1745-1922. Hospitals, spectacle and vice. By Gary A. Boyd. TLS, 30th June 2006

Thanks to Maren Meinhardt of the TLS, I have been getting the published text of pieces I have written for the TLS over the years. As it happens, a lot of these are from 2006, so a decade on, how do they stand up?

As a piece of prose, this is a rather sturdy, workmanlike review, with some clunky phrasing (“will find much of interest”)

The book deploys theory, as they say, in a way I was probably not all that familiar with at the time. It isn’t as effective as Susan Mat’s Homesickness: An American History in marrying a strong theoretical discussion with a readable, engaging narrative. Theory is often alienating, ironically since so much of it seems to be about power differentials and so forth.

Boyd’s work on Dublin reminds me of the previously-linked to posts by Philip Lawton at Ireland After Nama – as the review suggests the book goes well beyond 1922 until the present day – with the construction of a new Chidren’s Hospital and the ongoing closure of city centre hospitals this analysis is ripe for revisiting.

Medicine at the margins
Seamus Sweeney
Published: 30 June 2006
DUBLIN 1745-1922. Hospitals, spectacle and vice. By Gary A. Boyd. 224pp.

Dublin: Four Courts. Pounds 45 (paperback, Pounds 19.95). – 1 85182 960 1.

Georgian Dublin, to most Dubliners and tourists, evokes architectural splendour, an age of elegance and grace. It is often held up as a contrast to architectural and social developments in Dublin since, as an era of enlightenment and progress. Hospitals from the era such as the Rotunda, the first dedicated, purpose-built maternity hospital in the British Isles, and St Patrick’s, the “house for fools and mad”, founded with Jonathan Swift’s bequest, still retain their original function, or rather, still function as hospitals in today’s sense.

For this was an age in which the meaning of “hospital” underwent a change. Its derivation rooted in the Latin hospes, from which also come hospice, hostel and hotel; “hospital” in the medieval sense was not necessarily a place of cure or anything much by way of medical activity. It denoted a place that offered a wide range of possible services, from lodging and victuals to basic forms of care. They usually had an overtly religious mission. Dublin hospitals founded before the period covered by this book, such as the Foundling Hospital and the Royal Hospital Kilmainham, exemplified this older function.

It was also an age when “man midwives”, by stressing the dangers of parturition and the possibilities of a medical approach, were beginning to acquire respectability.
Nevertheless, obstetrics still stood in some disrepute. John Blunt’s evocatively titled treatise Man Midwifery Dissected; or the Obstetric Family Instructor, Containing A Display of the Management of Every Class of Labours by Men and Boy Midwives; also of their cunning, indecent and cruel Practices, proving that Man-Midwifery is a personal, a domestic and a national Evil typified this anxiety.

Homesickness: An American HistoryThis is the background to Gary A. Boyd’s architectural history -part of the Making of Dublin City series -which focuses on the Rotunda, or Lying-in Hospital, but is far from solely concerned with it. The book originated as an investigation of the relationship in the Dublin of today between the “official city” of civic buildings, monuments, museums, shops and galleries and an “unofficial city” of marginalized spaces; “alleyways, vacated buildings, empty lots” and the like. In the course of this, Boyd discovered that in any CCTV network, such as that which monitors the “cultural quarter” Temple Bar, whose culture now largely consists of stag and hen weekends and Sunday morning piles of vomitus, there are “shadow” zones which evade surveillance, due to various features of urban topography. Thus, “even in one of the most tightly controlled public areas of the city, therefore, certain uncontrollable and unpredictable activities existed”.

Boyd was moved to consider the lacunae in architectural histories of Dublin’s more famous and historic public spaces and buildings regarding the “uncontrollable and unpredictable” activities of those marginalized in traditional architectural historiography. This volume is an attempt to reclaim that human element. Boyd begins on June 4, 1751, with the Lord Mayor of Dublin and other dignitaries processing in state to the New Pleasure Gardens in what is now Parnell Street.

There Bartholomew Mosse, founder of the Lying-In Hospital, a man equal parts impresario and medic, supervised the laying of the foundation stone for what would become the Rotunda. Mosse threw an elaborate breakfast and “genteel and liberal entertainments” for the Lord Mayor and assembled gentry. This spectacle masked Mosse’s, and the hospital’s, precarious financial situation, and the New Pleasure Gardens would play an important role in hospital fundraising.

This incident typifies the close relation between spectacle and buildings with a public, ostensibly altruistic function. The new hospital did not simply serve a function as a maternity hospital, but acted as Palladian backdrop to the promenades in the New Pleasure Gardens. These Gardens were not just the site of elegant strolling, but of illicit assignations, what a later age would call “cruising”.

Thus begins a wide-ranging exploration of the tensions within Dublin, and within medicine, between medical function and issues of desire and social control. The dates given in the subtitle are somewhat misleading. The emphasis is very much on the early stages of the chronology. The book ends with a survey of the development of the red light area, Monto -which takes us to the 1940s rather than 1922, with Monto’s demise hastened by the work of Frank Duff’s Legion Of Mary.

Over the course of the book Boyd covers an impressively wide range of ground, from the work of the Wide Streets Commission, the Leeson Street Magdalen Asylum, the Lying-In Hospital’s admission certificate (reproduced in the book, with its rules including “That no Woman great with Child is to be received into the Hospital, if she hath any Contagious Distemper, or the Venereal Disorder”), the memoirs of the demi-mondaine Peg Plunkett aka Mrs Leeson, developments in hospital planning and management, the relationship between the military presence in Dublin and prostitution and many other topics.

Boyd’s analysis is influenced by Foucault’s conception of medicine as a locus of social control of deviancy, and by Murray Fraser’s work on the administration of late eighteenth-century Dublin. Fraser suggests that, rather than a simple expression of the power and pride of an Anglo-Irish elite, many developments in Dublin at the time resulted from the work of three powerful but conflicting bodies: the “Ascendancy” parliamentarians, the mercantile class, and the British administration in Dublin Castle. Fraser suggests that the work of the Wide Streets Commission, for instance, reflected a realignment of Irish interests with those of Britain.

Dublin 1745-1922 is lively and accessible -largely because Boyd quotes contemporary voices at length. His own prose style has enough wit and evident suspicion of the pieties of other ages and our own to keep the reader’s interest.

It is refreshing to read of issues that are often treated as purely medical or sociological from an architectural history perspective, albeit an architectural historiography strongly informed by social and political considerations. Some readers may find the influence of Foucault overbearing, and the occasional lapses into theoretical jargon somewhat off-putting (things are constantly “subverting” other things). Nevertheless, any Dubliner, anyone with an interest in the city’s history and development, or with an interest in the history of medical and obstetric practice, will find much of interest and find their impression of Georgian elegance modified.

#TRIALSYM15

The original purpose of this blog was as an entirely personal, reflective project. In the last few weeks (not that the blog has a history before this) it has become a forum for my reflections on events I have attended of a general medical innovation bent -the AMEE Hackathon and a CCIO meeting.  And now it is the turn of the inaugural Clinical Trials Methodology Symposium of the HRB’s brand new Trials Methodology Research Network. I only attended day 1 of this event which is a pity. The hashtag #trialsym15 is being used on Twitter so proceedings can be followed there. I won’t try and summarise proceedings here as it would be a little too much “he said… she said…” but give some reflective thoughts, especially following on from my prior posts.

As a full time clinician with an aspirational interest in research (ie a desire to take part in it that is often foiled) I find the concept of a network very appealing, and having an interest in conceptual issues in mental health and illness the methodology element is also fascinating.   It is rather invidious to select highlights; one was Sir Iain Chalmers , a founder of the Cochrane Collaboration (the logo of which incorporates a metaanalysis performed by an Irish doctor, Patricia Crowley ) who in a fascinating talk showed how, contrary to what is often taught, the randomised controlled trial did not emerge in 1948 from statistical theory but from a much longer history of clinical researchers engaging in fair trials of treatment.

Another was NUI Galway’s John Newell who gave the most engaging talk by a statistician I have ever heard

(his NUIG bio photo is also pleasingly Action Man-y)  john_newell

Newell gave a really honest and inspirational talk on translational statistics, and conveying statistical concepts to non-statistician audiences. I also learned about an egregious misuse of statistics by no less a moral authority than Fintan O’Toole … in a rather self-righteous article decrying the misuse of statistics. “The most entertaining talk I ever heard by a statistician” probably sounds like a set-up for a joke, but actually statisticians in my experience tend to be a wry lot. Newell’s talk really was the most entertaining talk I ever heard by a statistician.

I also enjoyed the total absence of the words “transform” or “revolutionise.” This was a particularly evident absence in Prof Craig Ramsay’s  witty, optimistic-yet-realistic presentation on  implementation science or knowledge transfer or (insert current description of this field here) . I had to pop out for a call towards the end (see the passing comment on not having time to do research above!) and, lurking at the door afterwards, was interested to hear him discuss developing research teams integrated into clinical settings. This chimed with some of my thoughts on the technology-health interface discussed towards the end of my Glasgow Hackathon post

The dynamic between technology and healthcare (and technology and education) is becoming one of the themes of these blog posts. My Glasgow experience made me wonder if the dynamic is, almost irretrievably, biased towards the tech being in the driving seat. I was more reassured by the CCIO meeting and even more impressed today by the amount of thought going into methodology by the likes of Prof Ramsay and the COMET Initiative .

Another highlight was Prof Peter Sandercock’s at times harrowing account of the travails of the International Stroke Trial and an illustration of the downside of social media and healthcare’s interaction. A questioner asked him about his current thoughts on pharma and drug trials. To paraphrase his reply, he said that he worried less about pharma influence, which is now highly scrutinised and regulated, than the medical device industry, which is not to anything like the same degree.

This got me thinking again about the deification of tech, or rather a certain kind of tech. Big Pharma is now a regular movie villain, whereas medical devices are Good Tech and therefore only criticised by fogeys. As it happened, during the day I came across a blog post by my  friend Phil Lawton  which, in dealing with the recent move of the Web Summit from Dublin, captured many of my own thoughts not only about the uncritical adoration of tech, but also about Dublin itself – especially as a Dublin native now happily domiciled a long long way away in Tipperary.