AN ANALYSIS OF MENTAL HEALTH CARE IN AUSTRALIA FROM A SOCIAL JUSTICE AND HUMAN RIGHTS PERSPECTIVE, WITH

i AN ANALYSIS OF MENTAL HEALTH CARE IN AUSTRALIA FROM A SOCIAL JUSTICE AND HUMAN RIGHTS PERSPECTIVE, WITH SPECIAL REFERENCE TO THE INFLUENCES OF ENGLAND AND THE UNITED STATES OF AMERICA: 1800-2004 Bernadette Mary Ibell, Dip.Ng.Ed, M Ed. Thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy. School of Philosophy, St. Patrick s Campus, Australian Catholic University, MELBOURNE. University Office of Research, St. Patrick s Campus, Fitzroy, MELBOURNE. July, 2004

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iii ABSTRACT The aim of this thesis is to analyze mental health care in Australia from a social justice and human rights perspective, in order to demonstrate that social justice as a philosophical manifestation of justice and fairness, is an essential ingredient in the theory and practice of mental health care. It is contended that the needs of the mentally ill would be most appropriately answered by the utilization of a Natural Law model, based on Finnis s Natural Law theory. The Scope of the Thesis. The needs and care of the mentally ill are discussed, together with the treatment meted out to these vulnerable members of society since, approximately, the year 1800. Neither the criminally insane, nor the intellectually disabled are included in this discourse. Each group of people merits a thesis on its own: criminal insanity requires a debate to include the history, psychiatric and legal approaches to the subject, and current management of the insane. The intellectually disabled are not mentally ill; their ability to function as all round, naturally competent individuals is diminished by an inadequacy and/or impairment of their intellectual capacities. The needs of these two groups are far too broad and demanding to be included within the current thesis. Rationale for the Timeframe. The timeframe, 1800 until 2004, has been established because it approximates to the transition from the end of the Classical through the Modern Age to the Post Modern Age, together with the predominance of Enlightenment philosophical theories, and the development of a scientific approach to medicine. Further, many politico-economic and social changes were taking place, associated with the Industrial Revolution. All are shown to have affected the introduction of asylumdom, and the institutionalization of those unable to participate actively in the industrial workforce. Of significant importance to the development of institutionalization for such marginal groups is the philosophy of Jeremy Bentham. Bentham espoused Classical Utilitarianism which will be shown to believe that the ultimate standard of utility is not the individual s

iv happiness but the greatest amount of happiness altogether. The thesis will demonstrate that this philosophical view prevailed from the beginning of the Industrial Revolution, with Benthamism influencing the sequestration of the unemployable into institutional life. Development of the Thesis. The thesis is developed against a background of prevailing philosophical, and other changes as stated above, including the medicalization of mental illness and the development of psychiatry as a branch of medicine. There is manifestation of many social injustices to those incarcerated in the asylum in all three countries under consideration: England, USA, and Australia. It is demonstrated that social justice and human rights of their work forces were disregarded by many employers at the time of the Industrial Revolution. Such values were, therefore, unlikely to prevail with regard to the mentally ill. Asylumdom continued with few changes in its practices until after World War II. It is shown that the predominance of post Enlightenment theories, together with further politico-economic, social and pharmaceutical revolutionary change followed the Second World War. Encouraged also by the founding of the United Nations and World Health Organizations as well as provision of the Declaration of Human Rights, circumstances led to the process of de-institutionalization of the mentally ill. The latter were decanted with apparently unseemly haste into a community ill prepared for such a change, and with little evidence of infra- structure to support the move. Need to conduct a National Inquiry. There was, then, a need to investigate what was now an overt issue of mental health care. The two subsequent inquiries by the Australian Health Ministers Advisory Council, (AHMAC) and the Burdekin Report, both focused on social justice issues, and addressed epidemiological, economic, sociological and justice considerations. Within the thesis, both investigations are critiqued against a Natural Law model, using Finnis s Natural Law theory. It is demonstrated that contrary to Enlightenment principles of social justice as described by Miller, such a theory is eminently practical, and answers the needs of all members of the community, providing not merely the greatest happiness for the greatest number but the common good of all Conclusion.

v Evidence shows that such a Natural Law theory is required to give a firm foundation to the needs of the mentally ill, especially at a time when relativism, economic rationalism and negative aspects of globalization prevail. Without such a basis the mentally ill are left insecure, uncertain and adrift in a world uncaring of their plight, while all the earnest exhortations espoused by Reports remain platitudes, subject to the whims of whatever government is in power. Our responsibilities to all our fellow human beings demand better from us than this.

vi ACKNOWLEDGMENTS In acknowledging the professional assistance received in writing this thesis, special tribute is paid to the work of Andrew Scull, Rodger Charles, SJ, John Finnis and R. Gowlland, archivist to the New Norfolk Historical Society of Tasmania, as well as to all others acknowledged throughout the discourse. Gratitude is expressed to the generosity of the Australian Catholic University, and to the unfailing assistance and advice received from my supervisor, Dr John Ozolins. Without his unstinting support and encouragement, this task could not have been completed. Appreciation is also expressed for the considerable assistance offered by members of the Federal and State/Territory Mental Health Branches, who supplied overwhelming numbers of publications outlining the changes in policy and mental health practices being attempted. A final word of gratitude goes to all those many sufferers from mental illness, who generously permitted their anecdotal evidence to be used, but strenuously wished to remain anonymous. This request has been carefully observed. Bernadette Mary Ibell.

vii TABLE OF CONTENTS Pages Title Page i Statement of Authorship ii Abstract iii-v Acknowledgments vi Chapter One The Concept of Mental Illness. 1-24 Introduction: The Aim of the Thesis. 1-2 The Scope of the Thesis 2-21 Rationale for the Timeframe 2-5 The Concept of Mental Illness: Who are the Mentally Ill? 5-6 Legal Definitions of Mental Illness 6-10 Sociological Implications 10-11 Medical Classification of Mental Health 11-13 Development of the Thesis 13 Justification for the Thesi 13-22 -Epidemiological Reasons 14-15 -Need to stimulate interest in professionals and members of society 15 -Need for a National Inquiry to address mental health issues 15-16 -Need to address economic considerations 16 -Need to address justice issues 16-17 -Need to investigate the policies and practices of mental health care in Australia 17-18 Framework for the Thesis 19-21 Footnotes 22-23 Chapter Two. Contrasting Concepts of Justice Arising out of Traditional (Natural Law) and Enlightenment Philosophical Views: Their Significance for Mental Health Care. 24-111 1.Introduction: The aim and overview of the chapter24-31 Chapter Two A 31-56 2. Contrasting theories of justice arising out of the Age of Enlightenment (The Age of Reason) and historically relevant to mental health policy making

viii Pages and mental health care 31-49 -Principles of Justice: formal and material principles 32-33 -Overview of the Enlightenment 33-34 -The Aims of the Enlightenment -Philosophers of the Enlightenment and their related theories of justice in relation to social justice and mental health care.35-49 -Considerations of Utilitarianism in relation to mental health care and social justice for the mentally ill 34-35 38-41 -Other Significant Theories arising from the Age of Reason 41-49 3.Moral arguments of the Genealogists and their relevance to social justice, mental health policy making and mental health care. 49-56 Chapter Two B 56-88 4.A Theory of Natural Law as described by John Finnis and related to the concepts of justice and social justice for the mentally ill. Construction of a Natural Law Model in accord with Finnis s theory of Natural Law. 56-73 5. Principles of social justice as interpreted by Enlightenment Theorists (the Encyclopaedists) and their significance for the mentally ill. 73-80 6. Conclusion 80-81 Appendix 2.1 Human Nature, Personhood and Individuality, showing the basis of Human Dignity and Human Rights 82-88 Footnotes Chapter 3 A 112-136 1. Introduction 89-111 Chapter Three: The Concept and Practices of Institutional Care (Asylumdom) 112-168 Chapter Three 112-115 2. A Definition of Asylumdom: historical factors which influenced its establishment 115-119 3.The Rationale for Institutionalization: more immediate factors which led to the foundation of asylumdom. The Psychiatric Factor. 119-136 Chapter Three B 136-151 4. The Reality of Asylumdom: what happened within the Asylum in UK, USA, and Australia. 143-152 -The Theory of Asylumdom 136-137

ix Pages -The Asylum in reality 137-151 In England 137-141 In USA. 141-144 In Australia 145-146 5. Psychiatric practices in all three countries. Outcomes of Asylumdom in each of these countries. 147-148 6.Conclusion 148-151 Footnotes 152-168 Chapter Four: Challenges and Changes to the care of the mentally ill Post World War Two 169-227 1.Introduction 169-173 2. Enlightenment influence on Pharmacological and Medical Revolutions affecting mental health care post World War II 173-181 3. The Shift in Philosophical views affecting psychiatry: Postmodernism and the anti-psychiatry movement 181-190 -The Anti-Psychiatry Movement: a challenge to psychiatry and to mental health care. 188-190 4. The resulting shifts in societal outlook: social, political and economic changes affecting mental health care. 190-203 -Social Change 191-193 -Economic Change 193-202 Redistribution 193-194 Economic Rationalism 194-198 Globalization 198-202 5 The concept of de-institutionalization: how it changed mental health care and why. 202-205. 6 Conclusion. 205-207 Appendix 4.1 Examples of Defence Mechanisms 208 Appendix 4.2 Factors contributing to patterns of thinking interwoven with 209 time

x Pages Appendix 4.3 Statement by Academics re. Economic rationalism 210 Footnotes 211-227 Chapter Five The Challenges of Social Justice and Human Rights Meeting the needs of the mentally ill in a climate of de-institutionalization. 228-309 1.Introduction 228-230 2.Implementing Natural Law in the modern world: a challenge to Utilitarian Social Justice Principles 231-236 3 Development of Human Rights Talk Post World War II: The United Nations and the Universal Declaration of Human Rights in relation to Mental Health Care. 236-248 4. Significance of the Australian Health Ministers Advisory Council (AHMAC) and the Burdekin Inquiry into Mental Health Care in relation to Human Rights, Social Justice and the Common Good. 248-273 - The Burdekin Report 251-268 -The Australian Health Ministers Advisory Council (AHMAC) Task Force 268-270 -National Mental Health Strategy: Four Policy Documents: 270-272 National Mental Health Policy (NMHP) 271 Mental Health Statement of Rights and Responsibilities (MHSRR) 271 The First National Mental Health Plan 272 The Medicare Agreements 271 -The First National Mental Health Plan,1992-1997 271-272 -Second National Mental Health Plan, 1998-2003 273 5. Current Mental Health Care in Australia in relation to Social Justice, Natural Law and Human Rights 273-277 6. Conclusion 277-280 Appendix 5.1Mental Illness Principles 281 Appendix 5.2 Terms of Reference for the Burdekin National Inquiry into the Human Rights of People with Mental Illness 282 Appendix 5.3 Commissioners appointed to the Burdekin Inquiry 283 Appendix 5.4 Contents of the National Inquiry Report 284-291 Appendix 5.5 General Conclusions to the Burdekin Report 292 Appendix 5.6 Clarification of the Significance of Finnis s Natural Law

xi Pages Theory and its potential to benefit Mental Health Care 293-298 Footnotes 299-309 Chapter Six: Conclusion 310-344 1. Introduction 311-314 2. The Scope of the Thesis. 314-319 3.The Age of Enlightenment and its influence on Mental Health Care 319-330 4. Changes bringing about the introduction of Asylumdom. The relationship between institutionalization and Benthamism recalled 329-333 5.Changes which brought about the demise of asylumdom. 334-336 6.Changes in the Western World following World War II leading to recognition of social justice and human rights needs of the mentally ill, with special reference to Australia. 336-343 6. Conclusion 343-344 Bibliography 345-375

xii Pages Appendices. Appendix 2.1 Human Nature, Personhood and Individuality showing the basis of Human Dignity and Human Rights. 82-89 Appendix 4.1 Examples of Defence Mechanisms 208 Appendix 4.2 Factors contributing to patterns of thinking interwoven with time 209 Appendix 4.3 Statement by Academics calling for a rejection of economic rationalism 210 Appendix 5.1 Mental Illness Principles 281 Appendix 5.2 Terms of Reference for the Burdekin National Inquiry into The Human Rights of People with Mental Illness. 282 Appendix 5.3 Commissioners appointed to the Burdekin Inquiry 283 Appendix 5.4 Contents of the National Inquiry Report. 284-291 Appendix 5.5 General Conclusions to the Burdekin Report 292 Appendix 5.6 Clarification of the significance of Finnis s Natural Law Theory, and its potential to benefit Mental Health Care. 293-298 List of Tables Table 1.1 Summary of Patients Rights 10A Table 1.2 The International Classification of Disorders- IX-R 12A Table 3.1 Numbers of Curable Patients in England and Wales, 1844 139 Table 3.2 Causes of Insanity. Commissioners Reports 1892 143 List of Figures Figure 2.1 Natural Law Model (Finnis s Natural Law Theory) 60 Figure 2.2 Schizophrenic Cats 66A Figure 5.1 Application of Halbert L. Dunn s Wellness and Illness Model to Mental Health and Wellnes 301A

1 AN ANALYSIS OF MENTAL HEALTH CARE IN AUSTRALIA, WITH SPECIAL REFERENCE TO THE INFLUENCES OF ENGLAND AND THE UNITED STATES OF AMERICA: 1800-2004 CHAPTER ONE THE CONCEPT OF MENTAL ILLNESS Introduction: The Aim of the Thesis The aim of this thesis is to conduct an analysis of mental health care in Australia from a social justice and human rights perspective, in order to demonstrate that social justice as a philosophical manifestation of justice and fairness, is an essential ingredient in the theory and practice of mental health care, evidenced in the provision of human rights for the whole community. It will be argued that if Enlightenment and Post Enlightenment philosophical views are understood as providing the basis for mental health care policies during the past two hundred years, that given their failure to provide adequately for the needs of the mentally ill, consideration should be directed to providing a new, Natural Law conceptualization of social justice. The aim will be to show that, against such a background, mental health policies can be formulated which safeguard more adequately the rights of the mentally ill. It will be shown that a philosophical framework based on Enlightenment philosophical thought describes the historical development of mental health care during the past two hundred years. Relevant Enlightenment theories such as Classical Utilitarianism will be described, in order to determine what influence they may have exerted over the policy implementation of sequestration of those incapable of participating in the workforce. The influence of the Genealogists through the philosophical views of Nietzsche and especially the Postmodernist Foucault, will be introduced, in order to consider whether they, in turn, have influenced twentieth century mental health care delivery. In order to do this, a conceptual approach will be used to include the historical background of mental health care in England, on which Australian mental health care was patterned, as well as the influence on mental health care policy in recent years of the United States of America. (USA) The significance of the United Nations and its offshoot, the World Health Organization (WHO) to mental health care as a result of the Declaration of Human Rights, will also be discussed within the context of mental health in Chapter Five.

2 The historical aspects of the past two hundred years of mental health care will be considered as a narrative account of the treatment of this marginalized group of society. In passing, it will also be shown to provide an insight into the Foucauldian employment of post-nietzschean understanding of the manipulation of history to subvert the project of understanding the project (MacIntyre, 1990:50). It will be shown that Postmodernist antagonism to the practice of Psychiatry could have had its origins in the rejection of the Aristotelian promotion of the liberal arts as the crafts of free persons (MacIntyre, 1990:66). In rejecting the concept of mental illness, the concept of the psychiatrist as a skilled practitioner with a basis in the art and craft of medicine is also rejected, subverting the concept of mental health care, by affirming the Postmodern belief that authority masquerades as domination and power (MacIntyre, 1990:66), in this case, in the shape of the psychiatrist. It is argued, however, that rejection of mental illness implies there are no mentally ill, perhaps just criminals. This is further marginalization of an already vulnerable people. These historical developments will, therefore, need to be borne in mind when providing a synopsis of the historical background of mental health care in England, Australia and USA. An analysis will be made as to whether previous mental health care policies were framed against an adequate conception of mental health itself. The Scope of the Thesis This discourse will address the needs and care of the mentally ill, and will consider the treatment they have received in the Western world since approximately, the year 1800. The thesis will not include direct reference to the criminally insane, nor will it relate to the intellectually disabled. It is believed that both these categories of people who have serious health care, social justice and human rights needs, merit theses to themselves. Rationale for the Timeframe. The timeframe, 1800 until the current period has been established, because many historians and sociologists believe that at the end of the eighteenth century and beginning of the nineteenth, a transformation occurred from the Classical Age to the beginning of the Modern Age (Scull 1993, Shorter 1997, Foucault 1972). Michel Foucault has argued that at that time, a mutation took place by which thought entered a new dimension from which it has yet to emerge (Pearson, 1975:145). Foucault has written that these ruptures offer clues to the nature of thought itself, and has traced them through the development of psychiatry

3 and medicine (Pearson, 1975:141). Foucault believed the ruptures outlined the historical limits of thought, so that if we try to trace the history of psychiatry and mental illness back beyond the nineteenth century, we will lose our way (Foucault, 1972: 401), because: Before the rupture men saw the world through a different grid of knowledge. (Pearson, 1975:146) By way of explaining this phrase, and in defence of Foucault s rupture of thought it must be stated that healing in the eighteenth century and well into the nineteenth had its theoretical and intellectual foundations in humoral medicine, not science. It was based on mediaeval physiology derived from the teachings of Galen, a Greek physician, who had taught that a person s health and character were determined by any of the four fluids of the body: blood, phlegm, choler (yellow bile) and black bile (Porter, 1997:75-81). Accordingly, one s disposition might be sanguine, phlegmatic, choleric or melancholic. The art of medicine was seen as producing and maintaining the body s balance between these fluids in order to sustain health. The physician believed that his cure- all : purges, vomits, bleedings and secret powders, the ingredients of which were known only to the specific doctor, were the weapons of choice to use against any and all types of ill- health. Consequently, the doctors demonstrable ability to regulate the secretions by bleeding, defaecation, urination and perspiration, gave them power in the eyes of the community (Porter, 1997:184). These concepts of healing were alien to the scientific mantle which medicine would don in the Modern Age, and to which the soon- to- be- established psychiatric discipline would aspire (Foucault 1973). (1) This rupture of thought Foucault described as an episteme, which he explained as a formation of knowledge in its broadest sense: a space of knowledge within which thought can take place (Pearson, 1975:146). In this sense, Foucault declares that the rupture of knowledge is delineating the limits of discourse. Because we cannot conceive psychiatry and medicine through eighteenth century thought processes, it is impossible to enter into dialogue with the rationale of treatment before the dawn of the modern age. Alasdair MacIntyre has claimed that in using the term episteme to describe the set of relations which in any given time unify the discursive practices underlying any one such body of claims, Foucault is mocking Plato and Aristotle s use of that word by which they described knowledge (MacIntyre, 1990:52). Plato was concerned with the nature of knowledge, and while in Republic 477e 6, he seems to suggest that the role of knowledge

4 should be reserved for that over which there cannot be error, Hamlyn has asserted that Plato was more concerned with what distinguishes knowledge from belief, construed as having something simply before the mind, and considered as true or false (Hamlyn 1971, in Honderich, 1995:242-5). Aristotle was similarly occupied and is stated to have repeatedly argued that we have knowledge proper (episteme) of something when we know its reason or cause. Knowledge proper, as Aristotle conceived it, entails bringing its object within a context of explanatory and reason-giving propositions which amount to science as Aristotle saw it (Hamlyn 1971, in Honderich 1995:243). By the nineteenth century, Enlightenment philosophical views predominated in England, North America and most of Europe. Before the Enlightenment, the traditional (Natural Law) Aristotelian-Thomistic understanding of ethics and morality formed the major philosophical view used throughout Christendom. Derived from Greek traditions of Justice, there was an accepted and understood nexus between Faith and Reason. This nexus was broken by the Enlightenment philosophers who believed in the use of Reason only. While Foucault as a good Postmodernist too rejected Faith, he would also reject the Encyclopaedist (Enlightenment) view that there was only one objective way of seeing things through the use of Reason. The relevant philosophical views of the Enlightenment and Genealogist (Anti-Enlightenment including Postmodernist) Schools will be discussed in Chapter Two. Only during the end of the eighteenth and into the nineteenth centuries would medicine gradually develop a scientific profile, and form the discipline which is recognizable today. Furthermore, census figures only began to be collected in England from 1801, so that epidemiological evidence became available. It was also at the beginning of this period that England came under the sway of the Enlightenment classical Utilitarian philosophy in the form of Benthamism, during which the sequestration of the unemployable became established practice, and asylumdom the preferred method of housing and treating large numbers of the insane (Giddens, 1991:158-160). The time frame then, would appear to be justified. For over one hundred and fifty years, from approximately the year 1800 onwards in the Western World, the mentally ill were confined to asylumdom. That is, they were sequestered within an institution, designed to protect both the patients from themselves and

5 the community in the name of safety. Within the specific building, supported financially by Local Authorities, or in a few cases, in privately owned houses, the mentally ill lived apart from the remainder of society, with a staff of attendants and under the supervision of psychiatrists (Mellett, 1982:160). Apart from visits from relatives, they formed an unseen section of society, unknown to the community at large, and rarely discharged once consigned to the asylum (Scull, 1993:309-310). How this situation came into being, how insanity was nominated and captured as a disease which could only be treated by the medical profession, what factors influenced the duration of the asylum for so long a period, and the effects upon the mentally ill of their removal from asylums (in Australia during the 1970s) back into the community, (the process known as de-institutionalization), will be analyzed within this thesis. During the period of asylumdom, and even since the rapid movement toward de-institionalization, it will be shown that mental illness policies and treatment, based on Utilitarian principles, were inadequate in providing social justice for inmates of such institutions. Because of these inadequacies, it will be argued that basing policies on a Natural Law Theory would improve matters, and it will be shown how such policies may be implemented to give the mentally ill justice on a parity with all other members of society. First, however, it is necessary to examine the concept of mental illness, and decide who are the mentally ill. The Concept of Mental Illness: Who are the Mentally Ill? To discover an answer to that apparently straightforward question is difficult. Until the end of the eighteenth century, mental illness (then known as lunacy ), was not considered to be a medical condition. Mental illness seems to have been accepted as a fact of life (Scull, 1993, Shorter, 1997). Life was mostly rural in England and Europe, and those members who suffered from seizures and other apparent manifestations of mental illness were cared for at home within their small village communities (Scull, 1993:8). This does not imply that their life was gentle and easy. Shorter has reported troublesome individuals as having been chained down in a corner of the stable (Shorter, 1997:3). In urban life, small hospitals existed. Bethlem in London was founded in the thirteenth century, and by 1403 housed six insane men (Shorter, 1997:4-5). Such institutions existed throughout Europe. Dorothy Dix would report similar conditions and institutions in Massachusetts, USA. at the beginning of the nineteenth century (Shorter, 1997:4-5).

6 From approximately the middle of the eighteenth century onwards, it was not unusual to find wealthy but insane individuals whose families found them difficult to manage, living in private houses in which they could be supervised, and which belonged to either a doctor or clergyman. Because these doctors often treated only the mentally ill, they became known officially as alienists, and will be shown to have played an important role in the establishment of asylumdom (Parry Jones, 1972). Only from the nineteenth century, however, would the insane in large numbers be identified as such, and isolated in institutions which demonstrably grew with time. Legal Definitions of Mental Illness. So what is meant by mental illness? How does the law define it? From the legal point of view, a legal model must surely safeguard human rights where the liberty of the individual is involved, by containing a clear definition of mental illness, because, implicit in law is a precision of definition, an exactness of what is meant by a statement (O Sullivan,1981). Likewise, working definitions of involuntary (confinement to the asylum by direction of the law) and voluntary status (confinement of the patient s own volition), as well as legal guidelines for admission and discharge processes would all appear to need legal exactness in their definition because again, in many cases, especially where involuntary committal which does not depend on the wishes of the individual is concerned, the liberty of the individual is involved. With regard to the legal definition of mental illness, O Sullivan has written that: Judges who must provide definitions where statutes fail, have not been too anxious to attempt to clarify mental illness. (O Sullivan, 1981:1) In the case W. versus L., L.J.Lawton decided: The words (mental illness) are ordinary words of the English language. They have no particular legal significance. How should the court construe them? The answer in my judgment is to be found in the advice which Lord Reid recently gave in Cozens v. Brutus (1973) AC 854, 861, namely, that ordinary words of the English language should be construed in the way that ordinary sensible people would construe them. (O Sullivan, 1981:1) These words imply that the term mental illness may be applied in a variety of situations to a wide range of people. Even if the term insanity is used, the law has shown little enthusiasm for its use (O Sullivan, 1981:1). Mr. Justice Devlin presiding over R. v. Kemp remarked: Insanity is not a legal term and there is no such thing as a legal definition of insanity. (1957, Q.B. 399)

7 Glanville Williams, however, a leading authority on criminal law has stated that the term is a legal one; it was used originally by lawyers believing it to be a medical term (O Sullivan, 1981:2). Whatever the legal disputes may be over the terminology, insanity is a term still in use in legal circles but applied to criminal law; however, criminal insanity is not a part of this thesis. The above discussion is included to demonstrate the varying expert opinions that exist in discussing the definition of mental illness. This evasiveness over confronting the definition of mental illness has progressed down the ages and mirrors the difficulty that both doctors and lawyers have faced in deciding what mental illness is. While the terminology of Lunacy Act had changed during the 1960s to Mental Health Act in most Australian States, on the eve of the Burdekin Report 1993, statutory definitions were still vague as the following examples given by O Sullivan show: New South Wales and the Australian Capital Territory Mentally ill person means a person who owing to mental illness requires care and treatment or control for his own good or in the public interest, and is for the time being incapable of managing himself or his affairs, and mentally ill has a corresponding meaning. (By Section 4) Victoria Mentally ill person means to be suffering from a psychiatric or other illness which substantially impairs mental health. (By Section 3) Queensland No definition attempted. By Section 5 (2) of the Mental Health Act, 1974, however: drug dependence (is a) form of mental illness. South Australia Mental illness means any illness or disorder of the mind. (By Section 5) Western Australia Mental illness means a psychiatric or other illness that substantially impairs mental health. (By Section 5) Tasmania Mental disorder means mental illness, arrested or incomplete development of mind, psychopathic disorder, and any other disorder or disability of mind; and mentally disordered shall be construed accordingly. (By Section 4) Northern Territory No definition attempted. (O Sullivan, 1981:8-10) O Sullivan has commented that presumably, with such vague, and in some cases nonexistent statutory definitions, the words of Lawton already referred to must have been

8 applied: that the words mental illness would be construed in the way ordinary, sensible people would construe them (O Sullivan,1981:1). But how do ordinary, sensible people construe them? Professional people are likely to discuss psychiatric patients, psychiatric hospitals and psychiatrists. More often, everyday language employed by members of the community speaks of nut cases, funny farms and trick cyclists.the use of such everyday language can affect our actions in our own everyday conduct with the mentally ill. Hare has stated that actions are...revelatory of moral principles, the...function of which being to guide conduct. (Hare 1972:1) The language of morals is part of prescriptive language. R.M. Hare has been a principal advocate in advancing a theory about the meaning of moral terms such as good and right. The theory contrasts descriptive meaning, in which language is used in order to state facts, and the prescriptive meaning which characterizes moral language (in Honderich, 1995:715). Wittgenstein has argued that meaning is given by use and is defined by context as a form of life (in Honderich, 1995:912). Hacker commenting on themes occurring in the philosophy of Wittgenstein, has asserted that: Speaking is not a matter of translating wordless thoughts into language, and understanding is not a matter of interpreting-transforming dead signs into living thoughts. (in Honderich, 1995:915) The possession of a language extends the will. It follows that the the use of terms such as nut case, funny farm and do-gooders, forms a language which can or might impose limits of empathy between normal speakers and their disadvantaged fellow-human beings. The objective of the language is to describe the user s view of mental illness and of the mentally ill. There is also the use to which professionals put the language. Wittgenstein in his discussion of language games illustrates the notion that professionals use language for their own purposes, within a particular discourse which others are not privy to (in Honderich, 1995:915). Following on this line of thinking, Antonio Gramsci, the Marxist philosopher, (1891-1937) also writes of how some groups establish hegemony over others by getting acceptance of the groups ideas as commonplaces; that is, the idea that there is only one definition of mental illness theirs (1971:323). This theme will be expanded upon in Chapter Three (pp.132-136)