Julian Cuddihy case highlights continued mental health stigma

The tragic case of Julian Cuddihy, who has been found not guilty by reason of insanity of the death of his parents, Kathleen and Jimmy, at their home on the Inishowen Peninsula, reveals much about the stigma we still associate with mental health.

Giving evidence at his trial, consultant forensic psychiatrist Dr Damian Mohan said Kathleen and Jimmy Cuddihy had cancelled a mental health appointment for their son six days before their death. He told the court that they were concerned about the stigma associated with mental health.

Julian Cuddihy’s story is one of loving parents declining to have their son committed to a mental hospital in case it caused a rift between them. This was despite his siblings’ view in October 2014 that he needed urgent psychiatric treatment. His symptoms of paranoia had been building for several years: Julian was refusing to eat because he believed his mother was trying to poison him; he could not sleep because he was worried people were stealing his thoughts while he slept; and he believed he could prevent aliens from reading his mind if he joined the IRA.

Despite their son’s mounting paranoia, Dr Mohan said his parents “wanted to be protective of their son but also did not want him to be submitted to a mental health facility”. Significantly, he added that mental illness is treatable with early intervention.

Delayed treatment

It is clear from the terrible narrative that Julian could have been diagnosed with schizophrenia several years before he killed his parents. He likely would have responded to treatment, at least to the point where his paranoid delusions would have been blunted. And while he may have suffered relapses, good community- based psychological care would have recognised this and stepped in to help. Since his admission to the Central Mental Hospital, Julian has reportedly responded well to treatment.

Whether we like to admit it or not, we are all complicit in the stigma that indirectly led to the death of Kathleen and Jimmy Cuddihy. Stigma is a societal weapon, a sometimes subtle but destructive force. Historically it has featured prominently in Irish healthcare.

When TB was rampant here in the 1950s, it was a diagnosis that dared not speak its name. In my time as a doctor we have thankfully moved from not mentioning the stigmatising word cancer, to references to the big C, to now openly discussing the diagnosis with friends and family.

But mental health continues to be hamstruck by stigma. Back in 2006 a Lundbeck Health Barometer survey found that 75 per cent of Irish people surveyed believed there is either a lot or some social stigma attached to schizophrenia while 60 per cent said the same about depression. Significantly, when the same people were asked about a range of medical illnesses such as heart disease, diabetes and arthritis, only a small percentage associated social stigma with these conditions. I wonder what the percentages would be if the survey was repeated now?

The media pay lip service to guidelines on reporting mental illness. Headlines such as “Schizophrenic’s family wanted help for him before axe killing,” which appeared over otherwise accurate coverage of the Cuddihy trial, give the false impression that people with schizophrenia are uniformly violent. There is also the subtle denigration in the use of the word schizophrenic, rather than a person with schizophrenia.

Our politicians and health service administrators are quick with honeyed words, but their embedded stigma is revealed by the ease with which they made a decision to strip this year’s mental health budget of €12 million to plug a gap elsewhere in the health budget.

And stigma exists within the health professions, too. Recent UK research showed psychiatry was the specialty that received the most disparaging comments when medical students voiced their career preferences.

Until we talk about psychological illness with the same ready acceptance as we do of physical disease, mental health stigma will not go away.

mhouston@irishtimes.com @muirishouston