Insights from the Outside: Scotland from an International Perspective

Kenneth Thompson MD

Associate Professor Psychiatry and Public Health

University of Pittsburgh, Associate Director for Medical Affairs

Center for Mental Health Services, Substance Abuse and Mental Health Services Administration

US Dept. of Health and Human Services

(for identification purposes only)

In Absentia

I have felt greatly honored and very humbled since being asked to speak at the Scottish Development Center for Mental Health ten-year anniversary conference and celebration. I am more than dismayed that I am unable to be there with all of you. Unfortunately, fate interceded when I injured my hand in car accident in August and then suffered multiple complications. I am now on continuous iv antibiotics for another 2 -3 weeks and cannot travel. So for now I can only take the no road to Scotland…. Aacchhh well.

Nonetheless I want to deliver some remarks if I can. Perhaps it’s a blessing that I cannot blether on as I might. What I have to say will necessarily be brief, especially since I can hardly type.

You might wonder why I think I have something to say and why I want to say it. Even more you may be curious about the source of the audacity I must have to offer insights from outside (shall we call them “outsights”?), though perhaps you might expect such behavior from an American. On this latter point please take all of what I have to say as the equivalent of a broad-faced American “Howdy!”. I am really just looking to engage.

As for why I might want to speak up, to try to contribute in some way, suffice it to say that my Glaswegian grandparents were central to my youth. I was raised with a love of all things Scottish. In 1960 my grandfather was knighted for his work with the Scottish Council for Development and Industry bringing American companies to Scotland after the war. Grampa became Sir Alexander Brackenridge and Granny became Lady Brackenridge. That kind of thing makes an impression on a 6 year-old grandson. After my grandfather died we spent several summers in Scotland visiting relatives- and there were a lot, since Alec had 6 brothers and sisters and Alice had 11. It has been a home to me ever since. I have friends and family there- and frequent contact.

What’s more, in many ways, the gritty cities and towns reminded me of my hometown, Pittsburgh is a city founded and built by Scots. The Scottish countryside and the Highlands felt like Western Pennsylvania and Appalachia. We are bound in transatlantic geological and cultural history.

I sensed a deep connection. I still do and I am prone to seek it out.

So I am a child of the diaspora, bleeding tartan. I gravitate here, pulled by the pipes, the pubs, the heather, the history, and neeps, tatties and haggis. And especially by the people.

But what makes me think I have something to say? In 1980, my wife and I had the good fortune to spend four months studying community medicine and the NHS at the Usher Institute under the tutelage of Dr. Una Maclean (who turned out to have been married to a relative of mine- John Mackintosh) and Fred Forster. That exposure to the ethos of Scotland - it was during the time that the Black Report was released- had a profound effect on me. Here was a country riven with social divisions that wanted to be better then it was- that had people and institutions that sought a more egalitarian future while preserving individuality and creativity. I am not suggesting that I thought Scotland was a revolutionary paradise. Far from it. But for this American child of the 60’s escaping the decade of the yuppies it was enough just to see honest active struggle. In particular what I learned at the Usher and saw in and around Edinburgh forever changed my understanding of health and illness, medicine and public health.

This may be a common place to you, but I came to see the story of modern Scotland as an effort to find a balance between the individual and the community. Now this is a struggle in the US and elsewhere, of course. What makes Scotland stand out is that, due to its history and cultural evolution, both sides of the balance come fully weighted. I don’t perceive an initial tilt in one direction or the other. How could it in a land that produced both Adam Smith and Red Clydeside? The Scottish historical project demonstrates that no one survives without community and no community thrives without the individual. Every day Scotland collectively poses the question “How can individuals and communities exist together, because we Scots can only exist if they do?” This tension and the solutions you seek also draws me here. Is it possible to create/grow a social ecology that will both sustain us all and permit each of us to thrive?

Perhaps it’s my interest and work on this issue that led to my invitation to address you on Scotland with its future in mind (I love the turn of phrase) and to note the work of the SDCMH.

Let me further my remarks by saying a word or two about “mind”. In my view, the relationship between the individual and the community/social world occupies the heart of our minds. I might reverse this and say it another way (while running the risk of further mixing metaphors)- “mind” is at the core of relationships between people. The Scottish project I outlined above is all about mind in this sense.

Let me now say a word or two about the future. Of course, who knows what the future will bring? Fortunately the world is changing so fast and so fundamentally that the present feels like the future- and we can know a bit about the present by knowing the past. So what is Scotland’s future? I don’t know except to say that it will not be a world class center of heavy industrial production earning its keep by the steam engine, metal production, coal mining and back-breaking labor. Those days are gone- just as they are in all the early industrialized countries. Not that the frame of mind, or better, the cast of mind forged in those days, has fully departed- the mind is more timeless- its future and present and past co-mingling. For better and for worse it seems to me that aspects of that mind linger in Scotland (and Pittsburgh)- like the contrasting sense of social solidarity and social division or bravado mixed with a lack of confidence or a drive for innovation and a mortal fear of change.

As Scotland moves to occupy another niche in the global economy how can you take these historic elements of mind and keep what works while discarding the rest? In particular, how will you build a socially-inclusive society that balances the push toward individualism, inequality and personal responsibility in the so-called knowledge or techno-service economy? What actions can salvage the people and communities lost in these dislocations? What strengths can be found and built upon- how can we use our history and our new innovations? In these circumstances, which services really help people and places recover? For the future, what makes a person, a people, a society, resilient? With society changing so fast and individuals increasingly cast to their own devices, what can be done to promote mentally healthy minds capable of navigating the increasing complexity and finding some sense of mutuality? How will we share the costs and benefits of our actions?

This is more then just a struggle between the individual and the group, though. There is another layer to keep “in mind”, a layer that has grown in importance as our ways of making a living have changed. Here I am speaking about finding a balance between reason, with its focus on rationality, effectiveness and efficiency (read “productivity”-the core of the new knowledge economy) and passion- the age-old feeling of living with purpose, meaning and love. Here again Scotland has a unique combination of both approaches. The land of the steam engine, the clearances, and “dolly” the sheep is intermingled with the land of Wallace, Burns, Mary Stuart, and MacDiarmid- with Hume setting the pace regarding the nature of the relationship between reason and passion “Reason is, and ought only to be the slave of the passions, and can never pretend to any other office than to serve and obey them.”

Can Scotland use its reason to help people individually and in groups to live passionate lives, filled with purpose, meaning and love?

Keeping Scotland’s future in mind means you are engaged in a critical experiment in mental health, democracy, governance and civil society.

You might think these are Scotland’s unique problems to solve. But they are not. Around the world the original industrial regions face the same concerns. These questions plague the rustbelts and played-out mining and agricultural regions all around the world. And some day they will plague the areas and regions going through their booms today- only to have to redesign themselves in the future.

No, Scotland isn’t the only place facing these quandaries, but it is the paradigm. I think you have much to teach us all.

The agenda of the SDCMH- improving mental health and well-being, tackling mental health inequalities and social exclusion, and developing and improving services for people clearly spans these concerns. The themes of this conference, Scotland’s people, places, and purpose focuses the issues on the circumstances Scotland (and by extension many other places) faces now. Perhaps, as you consider your plight and your assets and your future direction you might think about what your evolving understanding might mean for the rest of us in peripheral de-industrialized, mined-out and farmed-out communities and in those communities, now thriving, that will someday see hard times. Perhaps the land of the “invisible hand of the market” might help create a “visible hand” of international mutual support for people and places that seem to lose their purpose and their passion when the invisible hand drops them.

The Scottish enlightenment was tied to Scotland’s initial emergence as an industrial global power. Our new global economy demands a new enlightenment that can deal with the emerging complexities of our times- but hopefully this time while protecting and promoting our common humanity. What better place than Scotland to lead us forward again? What better time to focus on mental health and well-being with the future in mind? What better way to innovate and renew democracy- creating new opportunities- than out of ourselves- out of people, place and purpose? What better way to end this than to say, as a brash American, “Enlighten up again, Scotland, the world needs you!”