The chairman of the Royal College of Psychiatrists (Irish division), Dr G. J. Calvert, stated in a letter to this newspaper on Monday that I had cast doubt on the professional and ethical standards of psychiatrists and, at worst, had accused psychiatrists of malpractice.
He is correct.
I have cast and do cast doubt on the professional and ethical standards of psychiatrists and do accuse psychiatrists of malpractice. Not all psychiatrists, and not a majority of psychiatrists, but many psychiatrists.
I now want to go a stage further. The professional bodies concerned, including the Irish Medical Organisation (IMO), also have questions to answer.
These professional bodies have failed to bring to public attention the appalling conditions in which patients of their members are kept.
Of course psychiatrists are not alone to blame or even mainly to blame.
Various ministers for health over the last several years (Brian Cowen, Michael Noonan, Brendan Howlin, Michael Woods) all share in the disgrace that attaches to those most culpable for the abuse of thousands of the most vulnerable citizens in our State.
But back to the psychiatrists.
In the 1998 report of the Inspector of Mental Hospitals, it is stated: "Drug prescribing in some locations is often arbitrary and made without regard to appropriate clinical diagnosis; the number of patients, particularly long-stay patients who are on numerous drugs simultaneously, often at high dosages, was striking; in some instances prescriptions had not been reviewed for some considerable time.
"The inspectorate feels that in some services the practice of consultants in (regard to medical note-taking) falls short of what might reasonably be considered good professional practice."
WHAT could the arbitrary prescribing of drugs without appropriate clinical diagnosis be but a departure from good standards?
What could the failure to review prescriptions for some considerable time be but a departure from good standards?
What could the failure to take adequate medical notes in treating patients be but a departure from good standards?
But it is far worse than that.
In the last several weeks since I first starting writing here about conditions in mental hospitals and doing radio programmes on the subject, I have become aware that the abuse of patients by some psychiatrists is on a far more disturbing scale than that revealed by the inspector's report.
For instance, it has emerged that clinical drug trials are undertaken in some institutions without the consent of the patients or of their relatives.
Through letters, radio callers and people I have met recently at three meetings on mental health facilities, I have read or heard of maybe 50 people tell stories of apparent abuse by psychiatrists, abuse in terms of demeaning treatment, or refusal to consult on drug treatment, or involuntary electro-convulsive therapy (ECT) or arbitrary drug prescribing.
While it may be that the responsible bodies are unaware of the level of distrust and anger there is among many "survivors" (as they call themselves) of psychiatric services, they cannot be unaware of what the inspector has reported about the conduct of their members year in, year out.
And what has been done? Where are the inquiries into the prima facie breaches of professional and ethical standards? Where are the words of protest about the conditions in which psychiatric patients and mentally handicapped people have been kept?
But it is yet worse than that.
For years now, the Mountjoy visiting committee has been complaining about psychiatric conditions at the prison. For instance, in 1997 the visiting committee said the standard and quality of the psychiatric services continued to cause it grave concern. There were several weeks during 1997 when no psychiatrist visited the main prison.
It quoted Dr Smith, director of the Central Mental Hospital, as saying that at least 100 prisoners from Mountjoy should be in a psychiatric institution and not in prison.
The previous year (1996), the visiting committee reported that incarceration in padded cells for up to 10 days was the only option that was available for the treatment of these prisoners. It again quoted Dr Smith as saying: "The padded cell is a grotesque way of storing a human being."
IN 1998 the visiting committee said it was "dissatisfied that people with obvious psychiatric problems are being committed to prison". What has been done about this and about medical facilities generally at Mountjoy?
For a decade now, there has been a major problem about medical services at Mountjoy. Of course, the Department of Justice has been hugely remiss in not sorting out this problem long ago, but a major obstacle to sorting out the problem, according to informed prison sources, has been the Irish Medical Organisation which has blocked attempts to recruit additional doctors.
I gather that this issue has now come to a head with the new Prisons Service and remains unresolved.
So not alone is the major medical professional organisation doing little about clear evidence of abuse of professional and ethical standards in various institutions, not alone has it said little about conditions in which the most vulnerable people are accommodated, but it is open to the charge that it has obstructed the provision of elementary medical services to vulnerable groups in society.
Vincent Browne can be contacted at vbrowne@irish-times.ie