A quiet revolution in the way we treat those we mental illness is gaining support. Susan Calnan reports
Illness is often perceived as a condition where the individual loses a sense of personal autonomy or, in more extreme cases, where a person loses control or the ability to "think straight", to act "normal".
Ultimately, the person who is mentally ill is perceived as being outside of society in some way. They are, whether we care to admit it or not, different, and because we perceive them as being different in some way, we find it easier to ascribe medical terms - the person is suffering from depression; they are schizophrenic; they have obsessive-compulsive disorder; they are manic depressive.
Although the study of mental illness may seem like a well-worn path and the treatment of mental problems a finely tuned skill, there is nevertheless a quiet revolution taking place in relation to how, as a society, we view and treat mental illness.
Some might say it had its origins in a US group, set up in 1990, called MindFreedom Support Coalition International. This is an umbrella group for over 100 organisations in 14 countries, whose members consist of people who have been through the psychiatric system and of dissident psychiatrists who reject the biomedical model that often defines contemporary psychiatry.
In a nutshell, the MindFreedom group argues that mental illness is caused by severe emotional distress, often combined with a lack of socialisation, and it condemns the frequent treatment of mental health problems with prescription drugs - sales of which have increased considerably in recent years.
Moreover, it decries the use of electro-convulsive therapy (ECT), a treatment still used in many countries, including Ireland, and which it insists violates patients' human rights.
For its director, David Oaks, who will be speaking at a mental health conference later this week at University College Cork (UCC), the setting-up of MindFreedom International was largely a personal cause. In the mid-1970s, while he was a student at Harvard University, Oaks went through a severe emotional crisis and was diagnosed as being psychotic.
He was institutionalised five times and forcibly medicated, as well as being put into solitary confinement.
In his senior year at Harvard, he was referred to a volunteer organisation of "psychiatric survivors" called the Mental Health Liberation Front. Since then, Oaks has lobbied for a movement away from the biomedical model of psychiatric medicine.
Ultimately, what Oaks and his followers are looking for comes under the heading of advocacy: they highlight that people with mental health problems need to be agents in their own recovery and should have a say in the type of treatments they receive; they insist that people can and do recover from mental illness through proper rehabilitation, such as counselling, job training and housing arrangements, and without the use of drugs.
"This is an issue about choice," Oaks says. "As it stands, one narrow, medical model approach tends to dominate the mental health system, without providing people with a full and humane range of options.
"There is now a widespread misbelief that a 'chemical imbalance' must be behind people's mental and emotional problems; but people's thoughts and feelings are far more complex than just a chemical imbalance."
Closer to home, a group called the Cork Advocacy Network (CAN) - which has organised this week's conference with the Department of Applied Social Studies at UCC - has rallied together its own group of people who have either been through the psychiatric system or are carers of people with mental health problems, and are unhappy with the current psychiatric system in Ireland.
CAN chairman Greg White is a practising psychotherapist and has been involved in mental health human rights issues since the mid-1990s.
Like Oaks, White is passionate about the whole notion of introducing "advocacy" into our mental health services and about trying to understand mental problems from the point of view of the individual. He insists that there is still an enormous stigma attached to mental illness and that, as a result, many people are reluctant to share their subjective experiences of mental illness, often choosing instead to bottle up their problems and fears.
"People - patients, carers and medics alike - didn't, nor do they now, want to believe that 'mental illness' is a skewed medico-social construct, which ignores the shocking perceptions of a small but growing number of individuals, who have got through it and come out the other side," says White.
"In fact, the patients' views, let alone their feelings, are seldom a factor in the diagnosis and treatment of their problem. The great majority of people and patients accept the psychopathology of mental illness, simply because it is socially and medically convenient."
Consultant psychiatrist Dr John Owens, who is chairman of the Mental Health Commission (MHC) and is one of the keynote speakers at this week's conference, agrees with the notion of introducing greater advocacy for people with a mental health problem.
"One of the main interests of the commission is that people who are in receipt of mental health services receive it in such a way that they are allowed to participate in decisions about their own treatment; and in situations where they cannot, that they will have the opportunity to be advised and guided by an experienced and trusted person who can assist them," says Dr Owens.
He disagrees, however, with the notion that psychiatrists indiscriminately prescribe medication to patients, adding that the majority of mental health practitioners today realise that mental ill health is bio-psychosocial in its origins.
Dr Owens says one of the primary recommendations of the MHC is the setting-up of multi-disciplinary, community-based teams that will encompass a range of backgrounds, such as social workers, psychologists, psychiatrists, mental health nurses and other disciplines.
Nevertheless, he insists medication does have its place in mental health services, particularly for conditions such as schizophrenia and bipolar disorders, and that there are major biological factors involved in certain conditions, which can benefit significantly from medication.
Author of the book Beyond Prozac, and one of the leading voices in Ireland who has called out for a revision of our mental health system, Dr Terry Lynch agrees medication does have its uses, particularly as a short-term measure for people who have experienced a trauma or who are very distressed. He adds, however, that prolonged use of medication is often counter-productive and can create a dangerous dependency, without ever really getting to the root of the problem.
"This is one of the reasons why I don't like to use the term 'mental illness' because, in a sense, I don't actually quite know what that means," says Dr Lynch.
"The feeling of being distressed or overwhelmed by life is, I think, a much more accurate way of describing the problem, and by addressing these issues first, we can arrive at a much better solution."
The Limerick-based doctor, who is also a member of the Expert Group on Mental Health Policy, says health symptoms - particularly more severe symptoms such as hallucinations and hearing voices - are generally perceived by doctors as being outside the realm of understanding and therefore as something that should be eradicated, very often through use of medication.
"I think this is a misguided approach, because I believe that symptoms such as hallucinations and delusions can be understood in the context of where that person is in their lives at that time," says Dr Lynch.
"For example, one of the common trends that I have found in working with people with mental health problems is the underlying lack of self-confidence that they may be experiencing, or the enormous sense of fear and powerlessness, or their inability to express themselves and their needs.
"By working with those elements and trying to understand things from the point of view of the patient, I have found that often the original symptoms start to fade away.
"So, although I do advocate medication in certain situations, I think that we also need a system that helps people to overcome these problems - a system that enables people to develop their confidence, to re-integrate into society, to deal with unfinished emotional or psychological issues," he says.
"Ultimately, what we really need in our mental health services is a system that responds to the actual needs of the user, as opposed to their needs as perceived by the provider."
Cork Advocacy Network, in association with the Department of Applied Social Studies, UCC, hosts the Dignity, a Step towards Recovery in 'Mental' Illness conference on Friday at the Conference Centre, UCC.
'I feel that my life was taken away from me for 20 years'
Twenty-nine years ago Mary Maddock was admitted into a psychiatric hospital, just two days after the birth of her first child. Although she had no previous history of mental illness, she was diagnosed as having puerperal psychosis.
To this day, Mary and her family do not know who made the recommendation for her to be admitted.
During her four months in hospital, she was put on anti-psychotic drugs and antidepressants and given electric shock treatment. "I became a different person," Mary says. "The medication completely numbed me and literally took away my personality; I couldn't sit still for long and found that I wasn't able to concentrate on anything."
For the next 20 years Mary, who is married with two children, was put on a cocktail of different drugs, usually a mixture of antidepressants and anti-psychotics. The turning point came, however, when she started to experience terrifying hallucinations at night and the doctor she was attending decided to take her off one of the antidepressants completely.
"Once I went off that particular drug completely, the hallucinations started to go away," says Mary. "It was from that point on that I started to wonder if there was a connection between the medication and the symptoms I was experiencing."
After many months of research, Mary soon discovered that there were other people out there who had been through the psychiatric system and who were unhappy with their treatment, particularly with the over-emphasis on medication and the lack of dignity and self-respect they felt when institutionalised.
She also looked at other ways to help in her recovery, such as eating a healthy diet, taking regular exercise, learning relaxation techniques and using alternative therapies.
Five years ago, Mary went off all medication completely and now feels that she's back to her old self. She also became active in the Cork Advocacy Network, of which she is now secretary, and has recently set up with her husband an Irish branch of MindFreedom.
"To me, the most important thing is that people with mental health problems are given a choice and a say in their own treatment; so that if a person is put on medication, that it's their decision and not somebody else's," Mary says.
"But there should also be a much greater emphasis put on the simple things that people can do themselves - diet, exercise, music, proper sleep, relaxation - to help them in their recovery. I feel that my life was taken away from me for 20 years and although I sometimes feel angry about that, I want to channel this energy into helping other people through their recovery and to help them realise that there are different ways, and not just one way, of overcoming the pain they may be experiencing in their lives at that time."