Mind Moves: Sunday mass in Dublin City centre. A full house. As I rested into the warmth of the ambience and the beautiful Kyrie Eleison emanating from the choir, I heard another voice from somewhere at the back of the church. It was a troubled voice, loud and disturbing, refusing to leave, claiming the right to be in the house of God.
There were sounds of others trying to reassure him, to gently reason with him and ease him outside. But he was having none of it. He bounded up the aisle, closely followed by two gardaí, and it was then I recognised him.
He was a patient of St James's Hospital, a homeless man in his mid-40s who suffered with manic depression. He was agitated and paranoid - speaking rapidly about evil plots in our society, the Desert Rats, martyrs, God and spirituality. He had never been violent on the ward and I believed that he would not be so on this occasion. Contrary to popular misconceptions, the incidence of violence among the mentally ill is less than that in the general population. But listening to his ranting, you might have been forgiven for thinking otherwise.
He was confused and frightened and from the look on the faces of the congregation, it was clearly a frightening moment for them also. Mental illness had broken into the community of the sane and no one knew quite where to look. It struck me that the stigma around mental illness was born in moments like this.
I felt it was time to get involved and see if I could help out. If it had been any other member of our hospital staff, I believed they would have done the same thing. As I approached, I saw him move through the pews and settle down beside a lady who looked apprehensive, but who stayed surprisingly calm. I spoke to the gardaí, gave them a simple summary of his mental state and reassured them that he was unlikely to become aggressive.
They calmed down visibly and we considered what would be the least disruptive way to coax him outside. To forcefully evict him would require making quite a scene and they were reluctant to do so. After all, he wasn't a criminal, he had done no intentional harm to anyone, and the wrong approach could inflame an already heated situation.
I decided to join him in the pew where he was seated and see if I could establish some friendly contact with him. My efforts were completely in vain. He knew where I was coming from and that my presence could only mean a return to hospital, from which he had gone AWOL that morning. We stood for the gospel but I doubted that many present were able to take it in, as his voice climbed a few more decibels.
The accusations he hurled at me would be grounds for several tribunals. He moved out of the pew and I followed at a discreet distance. I didn't want to provoke his agitation, but I wanted to stay close by, as much for his protection as for those who were becoming increasingly unsettled by his behaviour.
There was an unexpected moment of calm in the middle of all this commotion. The choir began singing Rachmaninov's powerful Ave Maria and the intensity of the music seemed to calm him. He knelt quietly at the altar rails. When they finished, he stood up and gave them the thumbs up in appreciation of their excellence, and perhaps also for the brief reprieve they had afforded him from his mental turmoil.
The one guarantee with someone in a manic condition is that they won't sit still. I had said to the gardaí that he would keep moving around the church. If we could keep our distance until he was passing some exit, it might be possible to remove him with minimal disruption. That opportunity coincided with the consecration.
This sacred moment was juxtaposed with the scuffle of four individuals moving swiftly to where he stood by the door and his loud protests. With a firm purpose of amendment, the gardaí held him and escorted him off the premises. Outside on the footpath he was handcuffed and placed in a squad car that would return him to the only home he had. At all times, the young gardaí were respectful and gentle with him.
But they also imposed a boundary to his behaviour that he was incapable of doing for himself. And this had a considerably calming effect on his demeanour. As they led him to a waiting car, he looked at a female garda and said, "You're very pretty. Don't mind me love. I'm a Catholic, I wouldn't do any harm. I'm just a bit distressed at the moment."
Ironically, this happened on the feast of St Laurence O'Toole, who is remembered for his work with the homeless and the marginalised in the city of Dublin. It's not often we see mental illness in such an extreme form as was evident in this instance. But to some degree or other, it affects one in five of our population at any given moment in time.
Our fear of this form of human suffering is great. We may have taken down the walls that surrounded our mental hospitals, but we have erected walls of prejudice and stigma that continue to distance us from its presence. Seldom do we hear the same passionate pleas for increased resources for the mentally ill, as we have heard on behalf of those left waiting in A&E wards. And, unfortunately, those afflicted by mental pain are unable to be strong advocates for the resources they both need and deserve.
Dr Tony Bates is principal psychologist at St James's Hospital, Dublin.
