MEDICAL MATTERS Tom O'DowdMrs Brady is in again for her monthly supply of tranquillisers, sleepers and antidepressants.
All carefully calibrated to her mood by her psychiatrist. What she talks to me about is how much she hates living in our practice area.
The weekends are awful with youngsters drinking "and worse" in her front garden in the early hours. The Garda move them on but they have become more brazen over the years.
This has been her and Mr B's life for the last 15 years. The one good thing out of it is that their only son is a good lad and now working away.
Of course parents should do more with these kids, of course facilities should be better and of course off licences should not sell alcohol to 14-year-olds.
Our practice centre was stoned three years ago and €5,000 worth of damage done.
The good people of the area were mortified.
It was sorted out quietly and efficiently by imposing a curfew on the dozen or so 13- and 14-year-old boys and girls for the duration of the summer.
Jenny's 12-year-old daughter comes in requesting "me Mam's tablets". "She's not going out at all" she explains.
I have nursed her mother through agoraphobia over the last year and she seemed to be making progress.
It appears there was a few nights of cars tearing up and down her road recently which led to one word borrowing another.
Now Jenny is only able to find control behind her own front door.
The worst thing about it all is that the kids become streetwise and coarse when they should be children.
Of course they are pussycats when they are in my surgery and look bored and harmless as their mothers complain endlessly about them.
Schools do their best but if to show interest means exclusion from the gang the choice is inevitable.
When the GPs in my area were asked about additional services, top of the list came adolescents. When the families were asked they said the same thing. Out of control adolescents are intimidating and heading for big trouble. But it is trouble that medicine cannot fix.
General practitioners in deprived areas come under frequent pressure from parents and school to refer wayward and out of control kids to child psychiatrists.
It is an impossible request and yet we do it. It is not much use giving the parents a lecture on peer pressure and parenting skills. Try to communicate with a sullen kid in 10 minutes with the air heavy with recrimination and bare studded midriffs.
The long summer evenings are the worst. Long skidmarks on the straight bits of the roads indicate a night of so called joyriding. A still smoking car carcass means it finished late. The gangs seem to be unable to entertain themselves without risk and terror.
It is funny how experience affects ideology. My natural position in life is to allow people freedom and to trust them to use it wisely for their own benefit and that of society.
However, when that freedom begins to adversely affect the health and wellbeing of others it is time for society to act.
People should not be afraid to walk their own neighbourhood and should not be bullied by neighbours.
Neither should they have to take tranquillisers for 15 years in order to cope with a culture that permits gougers of both sexes to rule the roost.
Ireland has been careful in protecting the rights of individuals to go about their business and it is something to value and protect. We have recently shown an appetite for social and political innovation in such areas as criminal assets acquisition and workplace smoking.
We now need to apply this innovative spirit to the petty violence of everyday life in our deprived areas.
We have to let the residents get control back in our deprived areas by breaking the cycle of gangs, intimidation and social disorder.
This will mean the introduction of curfews and moving ringleaders out of the area for a period of time. Doing nothing leaves good people powerless, anxious and afraid to leave their own homes.
Like any experiment it needs to be planned, its implementation carefully monitored and outcomes measured.
We will gather valuable experience in the process and show good people that the state believes in a broad definition of health.
Michael McDowell the Minister for Justice is stepping up to the plate with ideas on social disorder that deserve serious examination. He is, however, going to have to deal with people who will accuse him of adding on to the nanny state where there are genuine fears that the state is taking over functions that are the domain of the individual.
Such criticisms come from people who favour "small" government, want to reduce bureaucracy and have low taxes.
In fact, political and social innovations that affect health seem to require political capital, legislation, resources and ultimately regulation.
If successful, maybe Michael McDowell will join Micheal Martin in the pantheon of favoured political sons when it comes to legislation that benefits health.
Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP.
Dr Muiris Houston is on leave