THREE TESTIMONIES OF SURVIVAL: Dealing with abuse, depression and cancerObsessive compulsive disorder, anti-depressant drugs and psychotherapy - Peter Thompson tells his story
Consider this if you will. You are concerned about the past. You think about it all the time. Every day and several times a day, you remember the years of your life. You remember them, however, not as they were, but as they should, or might, have been. You fix your attention on a particular year - say the year you left school - and, painstakingly, you imagine how you might have done things differently. You don't just do this for one year, you do it for every single year, right up to the present.
Then your interest in the past becomes your interest in the future. The mental process continues; you map out the future, all the way until (you imagine) you die, and even then your obsession - yes, that's the right word for it - doesn't leave you alone. No, you continue mapping out the future, except this time it's your children's future or, if, like me, you don't have children of your own, then your siblings' children's future or your friends' children's. On and on it goes.
As you are thinking, you start perspiring, your heart rate increases, your mind is concentrated solely on this vital function, which must be accomplished, of working out how it all should have been, how it must be, how your life and your descendants' lives will justify you eventually, your philosophy, your culture, your choices, you.
This is what I have experienced on a daily basis for over 30 years since my mid-teens, or possibly earlier, since symptoms of this condition were perceptible to my parents and brothers in my early childhood. It has a name: obsessive compulsive disorder, or OCD - in my case the "ruminant" or mental version of the better known physical-symptom version of the condition, now recognised as a factor of the mental illness known as depression. You probably have not heard much about this. The reason is painfully simple: nobody talks or writes about this condition because it is so embarrassing, it is too irrational.
Why don't people simply banish these thoughts? If it was that simple, pharmacological multinationals such as SmithKline Beecham and Pfizer wouldn't be spending millions trying to find solutions to what is, in fact, a debilitating illness, which forced me to stop work.
A new generation of anti-depressant drugs, known as Serotonin Selective Re-uptake Inhibitors (SSRIs), which include Prozac and Seroxat, have been much more effective in treating certain forms of depression, including OCD, than the older generation of drugs such as Anafranil. But they have excited controversy, well discussed by Sylvia Thompson (no relation) in these pages (Getting the Treatment Balance Right, Health Supplement, November 23rd, 2004).
As somebody who used Seroxat at its maximum dosage of 60mg per day for nine years (on prescription, of course) I wish to attest to its real value in combatting OCD, at least in keeping it at bay. Discovering a drug like this was a huge relief. However, it came at a price. Two, actually. Firstly, at the dosage I was taking I found Seroxat emptied me of all physical energy and sexual drive. Secondly, if I tried to reduce the dosage to offset that side effect, the OCD returned and I suffered horrendous nightmares and a very strong sense of desperation, even despair.
This effect from SSRIs, particularly Seroxat, has attracted criticism from some psychiatrists, particularly Dr David Healy of the University of Wales at Bangor who has warned of the danger of suicide from their use. Other doctors, including Dr Patricia Casey of UCD and the Mater Hospital, and Dr Ted Dinan of UCC's medical school have given varying degrees of support to the use of SSRIs.
I think both camps are right, in a sense. My experience is that careful supervision of patients on these drugs is needed, particularly if one proposes to come off them. Also, drugs on their own are not sufficient as treatment for depression. Here, the role of psychotherapy is absolutely crucial. Under the care of a psychotherapist - a properly qualified clinical psychologist - I have come off Seroxat recently, replacing it with a newer SSRI, Lustral, which, so far, and on a relatively smaller dosage, has produced fewer side effects.
The cognitive-behavioural psychotherapy, known as CBT, has been essential in a process which has allowed a partial return to work and functionality for me. So, psychotherapy? Essential. But there's the rub. I am blessed with a loving brother who is paying for this privately. While dependent on the General Medical Services (GMS), I was told by a doctor that it would take years for me to be seen by a State psychotherapist, that there was no point in even putting my name down for treatment! GMS patients are forced to rely on a perpetual assuaging of their problems by the use of expensive drug therapy, loosely (and therefore dangerously) supervised by their over-worked GPs, because of the non-availability of this essential psychotherapy part of their treatment. I know there is a shortage of suitably qualified psychologists, but this aspect of the health service attracts a low priority. This situation is absurd and wasteful.
One last thing, but also essential - alcohol. I have found total abstinence from alcohol to be an essential, indispensible part of my recovery. There is an extremely close link between alcohol abuse and depression. In assessing policies in relation to alcohol, and particularly its effect on young people, we should take this into consideration. Extending pub opening hours to 24 hours, providing 11 new bars in Croke Park and continuing to have alcohol companies sponsoring major sporting activities are definite forms of madness.