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Merriman Summer School 2014

The Emotional State of Ireland: To “balance all, bring all to mind”: Building a sustainable recovery by promoting our mental health. Professor Jim Lucey -Plenery Address

12th August 2014 to 31st August 2015

The Emotional State of Ireland:
Plenary Address 12/08/2014
Professor Jim Lucey

To “balance all, bring all to mind”:
Building a sustainable recovery by promoting our mental health

1. Ladies and Gentlemen, let me start by expressing my thanks to Professor Pat Coughlan and to all her colleagues at the Merriman Summer School, for inviting me to speak with you tonight. The topic of the Merriman Summer School this year is the emotional life of our country. It is a timely agenda as our nation approaches its hundredth birthday. Much of our national dialogue appears to be about economic and political agendas as though these existed in a vacuum. Recognition of the importance of our emotional health is necessary and progressive. I hope to bring to this conversation some insights gained from my work, but the views I express are all my own and they are my own responsibility.

2. The immediate question is this; What is the emotional state of Ireland today? More speculatively let me ask this: what is it about a nation or a culture that nurtures and sustains emotional wellbeing? The answer to this second question could inform us as we try rebuild our country following its financial collapse.  

3. In addressing you tonight I will draw from the published data in the research literature. In that sense this presentation will be evidence-based. Mental health knowledge is now properly informed by rigorous research rather than by theory, but I would also like to draw from my patients expertise. This is a method I have used elsewhere. Over the years I have learned more from my patients than can be said and I owe them a great debt. Their experience draws me daily to a more lived-in insight. To be a patient describes an experience that deserves respect. We will all be patients at some stage and this is part of what it is to be alive.

4. Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society. It is the real agenda behind most of our national narrative. Listen, if you doubt this, to the way we try to describe our daily challenges and you will hear attempts at the language of mental health. This imperfect vocabulary is the one we use to describe the conflicts in our family life and our community, in sport and politics, in our wars and economic and personal crises. There is hope in this language, but only if we can expand it and share it, authentically. So I am very glad to be here this week, as we talk together, trying to open up, even a little, a more genuine language of emotional wellbeing.

5. I wish to make a distinction between Mental Disorder, a state of recognisable dysfunction with a relatively predictable course and treatment, and Mental or Emotional Distress, a state of mental and physical unease which occurs in response to stress. Mental Disorder is relatively uncommon, with up to three quarters of the population spared throughout their life, but emotional distress is very common with almost everyone being affected to a greater or lesser degree at some time in their life. Of course Distress and Disorder can co-exist, and they frequently do, but far more frequently mental distress occurs in the absence of a mental disorder. Both mental disorder and distress are episodic and treatable, but the experience of mental distress is all the more challenging because of the fear which often accompanies it, the fear of falling into something much worse, something that is like madness.

6. One in four of us will have a mental disorder in our adult lifetime, and our rates of addiction and dependency are excessively high. Endemic stigma means this mental disorder is a clandestine experience, denied by most of us, even as it is experienced by many of us. For every family in our land (every family in this theatre) there is at least one person suffering mental distress right now. Professor Mary Cannon and her colleagues at RCSI have shown that “by the age of 24 one half of our young people will have experienced some form of a mental disorder and ……only a small minority will obtain any help”. The experience of a mental disorder such as depression or anxiety disorder in childhood is a significant negative factor for mental illness in adult life and it is a powerful predictor of economic disadvantage and unemployment. Tragically we have the highest rate of youth suicide in western Europe. As Professor Kevin Malone of UCD has written “on average, every eighteen days a child under eighteen dies by suicide in Ireland”.

7. Unfortunately the typical response to mental distress in Ireland is neglect (or postponement at best). This delayed response is agonising for patients and their families. It has been said that if your car breaks down today you could probably have it repaired within an hour, but if you or I have a mental break down today it is unlikely that we will get help for at least eighteen months! For anxiety and depressive disorders the delay can be as long as ten years before an effective intervention. The delay is largely in our inability to have the mental health conversation. Recently a number of celebrities have made strides by “coming out” about their mental health problems but for most patients the opportunity to discuss these needs is not available. Mental distress is as I have said a clandestine experience. In day to day terms patients live with an omertà about mental suffering which excludes them from the conversation. Patients experience this silence personally. It is as if no one dares to ask.

8. Unfortunately through the years psychiatry has become more narrowly defined, with medical concerns limited only to groups of patients for whom it is expected to provide a specific service. However there is a pressing need to widen our discussion because of the importance of our mental health. It is necessary for us all to enter the mental health debate. Whether these mental health concerns relate to our own personal challenges or to our family, our friends, or our communities, we are all affected. There is no “other” person when it comes to mental health. We are all “those other” people. Each of us could say in this sense that mental health is our issue. If each of us in this room were to raise our hand to say mental health is my issue a national conversation could begin. There is much said about our vision for change in mental health services in Ireland but for many this vision is an Ashling rather than a reality. We might debate the priorities in such a strategy, and why not have that debate? For many it is crucial that there is still no national strategy to tackle the problems of suicide in Ireland, others feel the problems and the costs of alcohol and substance abuse are still given insufficient priority, since in Ireland today the drinks industry has disproportionate influence, but if we were to raise our hand and say with regard to Mental Health “ I too am Spartacus” we would have a constituency sufficient to honour the challenge of recovery. This would be a constituency large enough to insist upon Mental Health becoming a culturally positive concern; a universal human right!

9. So what is it about our mental and emotional health which makes it such a taboo subject? The answer is complicated. It has not have been helped by the poverty of our language around mental well-being or by our asylum history of shame, fear and guilt. The problem is also with our mental and emotional consciousness, and this is political and social and cultural. Its a tall order to try to capture even some of these strands in Ireland but bear with me while I give it a go!

10. Modern Ireland is very different from the nation imagined by its founders. It is still as St. Colmcille called it “a small island on the edge of the world”, but today Ireland is struggling to become “the best little country in the world.. to do business in”. We might question whether this vision is sufficient for the real challenges we face. In some but not all respects Ireland has changed very rapidly. Todays Irish society is multicultural, multi-faith and without faith. Mass emigration has returned. National sovereignty has been undermined, (some would say it has been lost altogether), and we are operating in a global economy, conscious of our catastrophic economic failure. The first one hundred years of Irish freedom has been as traumatic as the century before it was tragic, and these memories are persistent. Memories of trauma are not usually lost even if they do not remain in the forefront of our consciousness. By recalling them here I do not seek to amplify our wounds or to weigh them against the history of other small nations. There is no parity of injury among the peoples of the world (to paraphrase Senator Mitchell of our peace process). The question is not whether our traumas are greater or lesser than other peoples, but whether we as a nation are addressing these problems in a functional way. It is not sentiment that makes us re-iterate our injuries, but a common belief that recognition of our traumas and of our response might help us to make progress. I share this belief.

11. Our independence emerged nearly one hundred years ago on the background of the great famine and of the Great War. The “peace process” which brought to an end thirty years of bloody civil war, a conflict we euphemistically called the “troubles” has left many questions still unanswered. Since then nearly every institution in the state has been discredited to a greater or lesser extent. With each shameful disclosure, Denial has been followed by incremental half truths seemingly extracted in dental fashion. This establishment response to distress, a game of cat and mouse with the truth, was well rehearsed long before the Banks collapsed. Decades of tribunals and enquiries established a pattern of denial that one of my patients calls “non-disclosure”, a tantalising alternative to genuine communication, characterised by the emergence of few revelations but multiple deceptions. In psychological terms this process of denial is damaging, not just because it postpones understanding and prolongs the struggle to find recovery, but because like Pavlov’s dogs we may have become conditioned to non-disclosure. Our faith in the availability of truth is important and it can be exhausted. Non-disclosure destroys trust publicly as insidiously as the original crime destroyed it covertly.

12. Of course denial is very understandable and very human. We all recoil from toxic revelations and we collectively “suspend our critical faculties” (as another of my patients described recently) simply to carry-on with our daily lives or to get our jobs done. There is nothing new in this. It may be that what was going on in the corners of “hidden Ireland” was always known but this knowledge was well out of reach of our collective consciousness. Certainly in the past we asked fewer questions and we were contented with a similar pattern of lies. This may be one reason for our shame and self-loathing.

13. The poet Louis McNiece articulates this self-loathing in his poem Autumn Journal where he decries our “sob stuff” and “our illusion that everyone cares”. He was writing at a time when hubris about Ireland was much more common. It was a belief, which now seems ridiculous, that we were a new and a better country, a safer country, certainly a much better one than our nearest neighbour. Despite much of the evidence, including decades of economic failure, it was acceptable then to think that “such and such a bad thing” would “never happen in Ireland”. Recent historians have described how to some extent in the early independent Ireland we believed “we were a chosen people…..a people set apart”. It was against this background of national self-deception that the earliest whistleblowers, as well as artists and reformers, must have struggled, since our processes seemed incapable of getting to insight. The failure of the Arms Trial was a watershed, which seemed to set a pattern, and so in modern Ireland questions still go unanswered.

14. On the other hand our stated beliefs about Ireland have changed and “changed utterly”. Now we are given to question everything, and now we know at least some of the truths. Our “states of fear” have been exposed so we now we know that in our asylums 2% of our population was incarcerated against its will. We know that many of our young people and vulnerable adults were physically and sexually abused in church/state institutions and Industrial Schools, in the Laundries, in the Mother and Baby homes and all the rest. These revelations have been so shocking that the sadness of it is too much to bear, too hard to hear, and yet we must hear it in order to understand and recover. We have only begun this work. Corporal punishment was not banned in Irish schools until 1982 and such assault was not outlawed in Irish creches and public care settings until the Children Act in 2001. In my experience in todays Ireland “domestic” violence and specifically violence against women and children in Irish homes goes on largely un-reported.

15. Still there has been progress, even if it has been insufficient to make us feel proud of our ourselves. After all, we are better educated and we are living longer and in many ways healthier lives. We have better roads and better phones, we have clean air and for the most part clean water. We have greater room for individualism and more individual freedoms. Our place in Europe allows us access to greater oversight of our human rights. In terms of health we have functioning emergency services, universal immunisation and (recently at last) more effective measures to reduce the peril of cancer. To secure all of this we have been willing to spend one third of all our national wealth to meet the cost of our health and social services and this apportionment is supported by a sizeable majority through taxation as a right thing in a just and democratic society.

16. Despite these positives the reality is that social and economic inequality is the biggest risk factor for poor health in Ireland. The unemployed (12.5% of our people) and those on low wages have substantially poorer health outcomes and shorter lives compared to their better off neighbours. The situation is even worse for the homeless. Recent reports from the charity Focus Ireland show that at least one family per day is being made homeless in Dublin. Who would have thought that the phenomenon of eviction would return to our country and on our watch, and this social disadvantage will bring with it huge health cost for all of us. Nowhere is this more evident than in mental health where the probability of being unemployed is far greater if you have a mental disorder, and where the life expectancy of those with enduring mental health disorder is significantly reduced (by more than 20 years) compared to the mentally well population.

17. The mental and emotional health of nearly one quarter of our population is in jeopardy. The most common disorders are depression and anxiety. The subject of depression is a difficult one, not least because every one has their own understanding for the “D” word. In the clinical setting when we describe a person as having Depression we mean this person is experiencing a characteristic set of emotions and feelings which are present on examination. These include pervasive and persistent low mood and loss of joy in life, even hopelessness and despair. In addition to these symptoms there are signs of loss of sleep, loss of concentration, loss of motivation and loss of energy. As with the subjective emotional components these objective motor components can be observed and measured. Central to the description of clinical anxiety is the experience of panic attacks with crescendos of fear followed by crippling avoidance. This is what we call Phobia; a fear leading to avoidance. This avoidance is also measurable and along with panic it is the most disabling “emotional” hallmark of Anxiety Disorder.

18. So what does the description of mental disorder in Ireland tell us about the emotional health of our country today? The exercise of placing a nation within a diagnostic system must surely be a folly. Even if our levels of mental disorder are high and our levels of alcohol abuse even higher, most of us are not mentally ill or addicted. In fact most of us are well and most are relatively contented.The truth is there is no evidence that we are a depressed or an anxious nation. The measurable hallmarks of low mood and all the rest are not endemic in Ireland today. We do not lack energy and certainly (when abroad at least) we possess the drive and concentration to meet most challenges and to succeed.

19. Equally the features of anxiety disorder are not evident in our nation. If anything, it is impulsivity that is more typical. Genuine courage in the face of adversity is evident in many places. This courage is evident in the spirits of most of the 200,000 Irish men and women who have emigrated from Ireland since 2008. They were not Phobic. They were ready to face great unknown challenges abroad. Sadly, for now at least, their energy will not be spent here.

20. Experience shows that in Ireland we are in distress and this is in response to the traumas of recent times. To evidence this we might consider examining the mental wellbeing of large sentinel groups of people in our country. This method has been used elsewhere such as in the work of Professor Michael Marmot the great epidemiologist who published his famous Whitehall studies of the health of UK civil service. His data replicated across the world is compelling about the nature of stress at work. The data show that the workplace environment can be seriously bad for your health and this jeopardy increases the more stressed and burdened you are, especially where work is characterised by lower degrees of control and reduced autonomy.

21. Our health services provide one such example of a distressed collective in Ireland. Despite huge successes in health (which go mostly unrecognised), the public hear daily of a cascade of failures, from the events in the Blood Transfusion Service, through the Hepatitis C scandal, and on to so many documented catastrophes in our major hospitals and community services. One result of this is the increased distress experienced by staff in todays health service. Predictably there are increased burdens of work arising from reduced resources due to our economic collapse, but a particular distress arises from the “gap” between the values which brought the workforce into healthcare and their perceived inability to deliver on these values in our broken system. This autonomy “gap” is highly distressing and has been associated with the emotional phenomenon known as workplace Burnout.

22. A similar distress is evident in many other areas of Irish employment where people feel powerless, stuck within their roles in seemingly discredited or broken institutions. Staff in the civil service, teaching, banking industry and our gardai provide many clear examples of this work place angst. Typically senior levels of management in these institutions react very defensively, especially when distressed individuals herald the distance their employers seem to have travelled away from their stated purpose. In this context in modern Ireland “whistle blowers” have been forcefully silenced. In reality distressed employees are much more common than has been recognised in modern Ireland. 

23. These same employees are also distressed because of the burden of personal debt that has been placed upon them. Many are in financial crisis since the collective burden for the resolution of our economic failure has been placed upon the mass of our citizens. This may have been expedient but as the recent local elections have shown it is widely perceived as unfair. As one of my patients said to me “all I got out of the boom was a kitchen extension and a power shower. Now I am responsible for 10% of a continental debt”.

24. Non-disclosure about our bank collapse means that we still know little about the real events leading up to the collapse of 2008. On the one hand our leaders have explained it all to their international colleagues; thus, in short, the Irish people were intoxicated by the boom and so effectively the people aught to bear the cost of their indulgence. At home the same leaders have told us that we were not responsible for our banking failure. The result is an incoherent message and this adds further to our emotional distress.

25. The Irish people although in distress have responded positively, at least financially, but Ireland has done this with the aid of one of the most primitive of emotional defence mechanisms. This method of denial is known as dissociation, a form of denial in which the distress is cut off and isolated rather than integrated and resolved. In times gone by this process was seen by Charcot in Paris and subsequently by Freud and his successors in Vienna as a commonplace. Todays patients rarely present with traumatic mutism or psychological paralyses, but in those times before the Great War astonishing manifestations of such dissociation where typical. The patients were often noted to have an attitude known as “la belle indifference” by which was meant a complete disconnection from their pain, indicating a complete denial of the mental distress central to their affliction. Modern psychiatrists under the biological influence of neuropsychiatrist Elliot Slater rarely make these diagnoses. We rarely see such obvious examples of dissociation, but the tendency to distance oneself from distress and to compartmentalise it has not gone away. Indeed if we take the example of President Bill Clinton “compartmentalisation” is frequently celebrated. In Ireland twin denial processes of non-disclosure and dissociation maintain unsatisfactory analyses. In the end the attitude parodied by Seamus Heaney is to the forefront in Ireland “What ever you say, say Nothing”

26. The problem is that dissociation is incoherent. The splitting brought about by dissociation is only a holding mechanism for emotional distress, it is not a route to recovery. By dissociating nothing is learned from the trauma since it is cut off. The dissociated injury just persists in a different place but without an address. This distance from reality, through dissociation, can be achieved nowadays by intoxication or the distraction of violence, or money, or politics, or power, but ultimately when trauma is dissociated nothing gets done about it. Since nature abhors a vacuum the dissociated space is inevitably filled with incoherent feelings of frustration, anger or despair, and since it is disconnected it cannot be understood or resolved.

27. It may be that as a “culture”, we are destined to split. We have lived with partition and for many years we maintained our half truths either side of the barricades. We still build Luas lines that do not connect and we hardly wonder at it. It was Brendan Behan who joked that in Ireland the first action of any group was the management of its “split”. Indeed the main divisions in our political process are based upon civil war splits which have not been addressed even though they have little or no current justification or utility.

28. Either side of the divisions in Ireland, dissociation allows us maintain our demands, justified by our separate historical analyses, and un-informed by the history of the “other”. Dissociation in Ireland does not produce “La Belle Indifference” but something more like “Wounded indifference” (as one of my patients described it), in which the many dissociated parts feel they have little need to communicate with or understand each other. After the first 100 years of our independence it is time to develop a better mechanism, one with renewed emotional skills, a more integrated Ireland, an Ireland united in a meaningful way.

29. In our next century we could learn from our experience to create a culture that promotes and celebrates our mental health. We could prioritise the wellbeing of our people and build a concept beyond our current ideas of wealth. The mental capital of our country is our economic capital, and our economy can thrive again only if we include all those currently in distress within our recovery plan. 

30. I remember as a child being encouraged to collect for the Irish Wheel Chair Association. I naively thought we were collecting money for people who were confined to life in a chair. It wasn't until much later when I got to know many people who are in wheelchairs that I realised that what we were actually doing was was much more. We were opening up our consciousness, building our awareness of the need for widened doors and modified buses and ramps. It was always a human rights issue. Back then we were less aware of a segment of society that was denied rights of access to theatre or sport or work. Now we all insist a ramp be there for all the wheelchair bound. In tomorrows mental health culture we might also insist on a ramp for those in mental distress, so that they can access recovery and quickly partake in a life made expert by their experience.

31. Not long ago we used to ask ourselves whether Ireland was closer to Boston or Berlin, a question motivated mostly by our desire for sources of foreign direct investment, but unconsciously the question represented an uncertainty as to the nature of our new society. The choice was between a more individualistic society, and a more collective one. 

32. The crash brought a new tension to this binary dilemma illustrated for me at a seminal moment in our economic collapse, when the economist Colm McCarthy tried to explain to the Irish people the necessity for the emergency financial measures. On RTE radio he explained that the “Irish government had not run out of compassion, but it had run out of cash”. For compassion read any number of values (other than monetary ones). Now ask yourselves how many compassionate values have been re-articulated and re-emerged since the departure of the Troika and with them the departure of our cash. Surely a renewed conversation about values would be restorative. Perhaps then the emotional and economic value of our homeless and unemployed would be acknowledged. Just as the emotional consequences of excluding the mentally ill needs to be recognised, the right to more effective means of recovery for all our people and our society needs to be endorsed.

33. So is there hope? Absolutely there is hope! Our tendency to denial, dissociation, and non-disclosure, may not have helped us resolve our conflicts to date but ultimately we must re-engage if we are to recover. The crash may have weakened much of the cultural fabric in our counties, towns and cities, but eventually we can rebuild. How then can we move on from the distress of our past? 

34. This question is surely important for any nation which truly wishes to make progress, but only one nation that I know of has a specific word for the process. In Germany they call it “Vergangenheitsbewailtigung” or “wrestling with the past so as to come to terms with it”. 

35. The meaning of this process for the German nation has been profound and the benefits are measurable. Through “Vergangenheitsbewailtigung” the complicity of the church and state in Germanys terrible history is being addressed by a mutual dialogue. Denial is no more tolerable there than is dissociation. The result has been a cultural rebirth. Now as our one hundredth birthday approaches is it possible that we would begin a cultural renewal based on a genuine dealing with our past? The time is right but it is not certain we will take the steps necessary, even though the alternative is a repetition of the past with dreadful consequences. As Santayana predicted, “Those who forget the past are doomed to repeat it”. The truth is that those who fail to learn from the past are even more likely doomed in this way. Other european countries have been less successful in the process and their fate has been less successful, but the Germans have engaged with it at political and philosophical levels, in high culture and in low culture. By asking important questions german philosophers such as Theodore Adorno have helped its people to understand “What it means to work through the past”. Here is a real cultural engagement which tries to tell the whole truth and to engage fully in making a new and better society.

36. Such an authentic process in Ireland would require great leadership and widespread cultural dialogue, but through it the emotional burnout of our people and of our institutions might be reversed. Such a cultural process might even come to the rediscovery of values beyond purely monetary ones, including the renewed values of atonement and respect. 

 37. A meaningful and inclusive dialogue could lead to the reform of our work places. Our distressed employees also need renewal. Returning to our example within the health services sector, something like this may already be happening. Michael Porter who is Professor at the Harvard Institute for Strategy has proposed a new vision of health care based on an integration of value as its main aim. It is helpful to reduce this idea to a simple equation where Value equals Quality of service divided by the Cost of the service and multiplied by the number of people who have Access to that service. One might dispute any of this, but the key is that values such as quality and access are all in the consideration, not just cost. Furthermore the derision for health services arising from the accusation that health is an elastic need with never-ending cost is challenged by the inclusion of quality and access as well as cost into the equation. This is real Value and that is what matters.

38. A renewed cultural conversation could lead to the integration of value based parameters in our whole work force, throughout our civil service and our gardai and our banks and our schools, and everywhere else where the crash has caused the content of work to be reduced to a quantum of debt at the expense of all else of value. The truth is that values and cash need not be mutually exclusive. We have been asked to make a false choice. It is possible to have compassion even when the cash is scarce! For those left counting the figures it is worth knowing the evidence, such as provided by Michael Marmot, that a renewed respect for our workforce would make for a happier and therefore much more productive working culture.

39. A cultural wrestling with our past could lead to the rebuilding of our country on universal principles of human rights. Into our second century we could emphasise priorities that would make our young people and our old people strong and emotionally resilient. We could begin to include our homeless and our mortgaged, our emigrants and our imigrants, our believers and our unbelievers in a journey towards an Ireland that would be well and not only well-off. This would require more than just a declaration that we would “cherish all the children equally”. It would even be more than an amendment to our constitution however important that first step has been. What would emerge through an acknowledgement of our failure to cherish our children in the past would be a consideration of the best way to cherish all these children in the future. 

40. An emotionally healthy Irish life is not something that will happen by chance. The ability to live and work and love needs to be integrated by a healthy brain and a balanced life which incorporates many lively human capacities. Many mental disorders have an organic brain basis but mental and emotional distress has a critical influence on the health of our people. The social factors of nurture and education, employment, recreation and human contact are hugely contributory. To have mental health we need a balance of these things, such as sleep, exercise and sport, employment, food, music and laughter. We will be well when we can laugh as often as possible, when we can take care of our selves and ideally take care of some one else as well, and most of all when we can be kind to ourselves and to each other.

41. Certain key elements contribute to the development of a mentally healthy, emotionally resilient populations. These qualities are known as Resilience Factors. Based in part on the work of Sir Michael Rutter, Professor of Developmental Psychopathology and others, the Domains of Resilience (Daniel and Wassell) have been identified. They include a secure base, education, social competence and friendships, talents, interests and positive values. A renewed Irish society dedicated to building these resilience factors might prioritise them as much as finance or foreign affaires, and so future political and cultural decisions could be made congruent with these goals. The difference from our current politics would be profound. An evidence-based template guiding us towards a stronger more resilient population would surely be the one to adopt. A renaissance of our culture, of life and work and spirit, balanced with our sport, music and arts and respect for beliefs could emerge from this shift in our priorities. This working towards positive values would sustain growth; and with resilience the next generation could grow together to better withstand its traumas and rebuild itself. 

42. Despite substantial levels of mental disorder and emotional distress there is great hope for our future, if we come to terms with our past. International experience provides powerful examples where the discovery of a dynamic process made it possible to wrestle even with the complicity of church and state in terrible crimes. If such a health process were to gather momentum in Ireland a rebirth of cultural values could begin. Out of a sincere re-engagement with our history we could make peace with ourselves and rediscover what it is to be truly mentally and emotionally well; so that more people could live independently, work productively and most of all love each other with a whole heart. 

43. The challenges in our community and in our work place would benefit from reconsideration, informed by international experience and research rather than by the reiteration of well rehearsed factional positions. An authentic acknowledgement of our use of denial and dissociation would allow us to make radical changes. A consensus could emerge within Ireland, of cultural and political interests dedicated to the same recovery. We could at last base our strategy for our children's development on a strong footing and incorporate in a renewed Ireland an enlightened commitment to their welfare. 

44. In conclusion, our path to recovery can only be sustained by promoting our emotional mental health. In Ireland, as in life, traumatic experience has not been avoidable, and our mental and emotional health may have taken a beating, but what matters now is that we can respond. To borrow the stoical motto of Ernest Shackelton, a great Irishman of nearly a century ago: By endurance we conquer! Our recovery can be more than a reactionary stoic response to trauma. Now we can build our resilience positively. As the psychiatrist George Vaillant put it more recently: when we learn through our experience we can triumph!


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