Heart Beat: I may well be repeating myself or you may have heard it all before from some other source, but I do approach this topic with a sense of deja vu. This simply reflects historic frustration at the failure of political decision makers to recognise and address the enormous difficulties facing the practice of psychiatry today and in the past.
Let's take it as a given that I have decades of coalface experience in psychiatry - I can legitimately talk about it. I can also claim some insight into political mindsets from years of rubbing shoulders with politicians as a health board member in the recent past.
During that time I have to admit I enjoyed the company and the "craic". Politicians are a personable lot, no doubt about it, socially skilled, good at pumping flesh and kissing babies or vice versa, good fun to be with.
For years I lulled myself into believing that I would get some real help from my new-found friends and board colleagues at planned and prompted sub-committee meetings at the Central Mental Hospital in Dundrum, where I worked for decades.
We were in dire straits at the hospital, I hardly need to tell you, with a degrading environment crying out for attention and help. I am sorry to say that very little came of the meetings apart from plans, promises, good intentions, architects engaged, etc. The politicians went back to their constituencies and we lived on in hope, pretty naively in retrospect.
It must be about 15 to 20 years since we first had ministerial visits at Dundrum. Two if not three government ministers were shown around our hopelessly inadequate clinical environment, visiting our disgraceful seclusion area in particular, and all of them walked away.
Micheál Martin, years later, at least had the decency to describe what he saw as "grim", but we had to wait until Mary Harney had the courage to condemn our admission unit as "unacceptable" before any funding started to flow our way.
I am certain that our Dundrum experiences were repeated all around the State. Why? Why would respected political leaders walk away from such situations, leaving our sorely disadvantaged patients behind in their ghettos, dulled with pain until indifference and institutionalisation set in?
The answer is not blowing around in the wind; rather it resides in the political subconscious.
All of us, including politicians, know that at some stage we, or a member of our family, will need help - the services of a physician or a surgeon maybe, or an oncologist perhaps, or a hospice, etc.
But very few, including politicians, ever anticipate the need for psychiatric help in the future. This is despite the statistics; for example, the 1 per cent lifetime prevalence of schizophrenia. Basically, what is not anticipated is not funded, and psychiatry loses out. That is a pretty straightforward suggestion, I assume.
Let's move to something a bit more obtuse as we search for a more subtle explanation of a complicated situation.
ERIC FROMM, A psychoanalyst now deceased, used to argue that we no longer repressed irrational sexuality or aggression. This has been replaced with "the repression of what we know to be true".
When asked for an explanation, he gave the selection of Nixon as president of the US as an example. The stigma of psychiatry, the rejection of psychiatry, and the suggested repression of what we know to be true - in this case the obvious needs of psychiatry - all contribute to its political neglect, I believe. And there is more to it.
I happen to feel there is a predominance of narcissism in political lives. Need an example? What about all those brushed-up, studio-fashioned photographs tied to every lamppost and gate during election time?
I know we all spend a little longer over photographs of ourselves when browsing through family albums, but imagine spending a lot of money (come to think of it, from political donations) just to see your image, distorted of course, false of course, in every street where you live.
Point made? Narcissism alive and well and by definition inner directed, spending on self rather than others. This is important, for the politician spending on self translates into spending in his/her own constituency, in his/her own back yard, where the votes come from.
I was convinced at one stage that north Dublin city or county politicians had no interest in spending money on Dundrum. This group was more likely to support investment in St Ita's, with its locally based staff voting power and strident public advocacy. Dundrum had no voting allure and, until recently, no public supporters. So there you have it.The gospel according to Smith. Narcissism and repression of the truth leading to political stalemate.
That's why I welcome the establishment of the Health Service Executive. At least Prof Brendan Drumm is not a classically reared or moulded politician and he brings the real possibility of a new approach to health planning which is urgently needed.
Addendum: whatever process unfolds, please keep the Central Mental Hospital at Dundrum. Sell one-third of it if need be, but do not juxtapose the hospital and a prison, and do not repeat history by, once again, moving the patients and their carers out into the country, out of sight, out of mind. Let them stay where they are.
• Charles Smith is a former medical director of the Central Mental Hospital, Dundrum, Dublin. Maurice Neligan is on leave.