MEDICAL MATTERS: A couple of books on health from Irish authors have come to hand recently: From the Heart by Prof Patricia Casey and Fibromyalgia, Fatigue and You by Dr Michael C Kelly.
Prof Casey is well known to The Irish Times readers and is one of the more visible faces of psychiatry in the country. A professor at UCD and a consultant in adult psychiatry at the Mater Hospital in Dublin, Casey writes a regular column in the Evening Herald. Her book has its origins in these columns; it is written in a question and answer format. In her introduction, Casey says those with mental health problems are often stigmatised and regarded as different from others in a way that is distinct from those with other medical conditions.
"There is a substantial body of research demonstrating that the best antidote to fear is knowledge. Those who have personal knowledge of or contact with mental health problems are the least likely to feel fearful or ashamed. This book was compiled with the aim of challenging the negative stereotypes that are frequently applied to those who have mental health problems," Casey says.
It certainly covers a broad range of issues, from alternative therapies to suicide. Casey is not afraid to confront some issues close to psychiatry itself. Dealing with a question that highlights the rigid sectorisation of psychiatric services in the Republic - whereby your address is the key to which psychiatrist you are referred to - Casey acknowledges that this system "seems rigid and can be bureaucratic at times. One of the problems with this type of sectorised service is that it does not allow the flexibility that you might wish for."
A key issue here is what happens if the patient and the designated psychiatrist do not hit it off. Hardly the basis for a beneficial therapeutic relationship.
A section on depression and manic-depression poses a number of questions that are very real for patients taking medication. With recent news stories questioning the side effects of Seroxat and other anti-depressants, the book reflects these concerns. However, Casey is unequivocal in her responses to issues concerning addiction and the length of time people with significant depression must remain on medication. She recommends continuing antidepressant medication for six to nine months after the person begins to feel well.
Commenting on Seroxat, she says: "It is regrettable that the recent coverage about this drug was so sensational... in spite of the fears raised about the possibility of it being addictive, there is no evidence for this at all."
Prof Casey's book has both depth and breath; it is fully indexed allowing the reader to zone in on a particular area of interest.
Dr Michael Kelly is a consultant rheumatologist in practice at the Bons Secours Hospital and Blackrock Clinic in Dublin. Fibromyalgia, Fatigue and You is the second edition of the book but, as the author outlines in his introduction, this edition attempts to show people with the chronic condition how to effect the life changes that make it easier to live with.
People with fibromyalgia experience widespread pain and tenderness, especially in the shoulders, neck and the lower back. The pains are felt in fleshy muscular areas of the body. While pain is the major feature, it is accompanied by fatigue and mood changes. Numbness in limbs, abdominal bloating and intolerance to cold and heat are less common symptoms. There is no clear explanation, in biological terms, for fibromyalgia. Lots of theories exist, including a viral cause, immune system dysfunction or hormonal changes.
However, no one is really sure what causes the condition. Dr Kelly acknowledges the difficulties this poses for patients; as well as the reality that most people with the condition will get, at best, partial benefit from treatment.
Part one of the book is devoted to learning about fibromyalgia, including possible causes and treatments. But it is Part 2 that differs substantially from the original edition. Titled "Realisation", it is based on the author's extensive experience in managing patients with fibromyalgia. Kelly refers to "the emotional and psychological distresses that are such an integral part of what might be called full package fibromyalgia".
A chapter on "Attitudes Towards Self" probably goes to the heart of where Kelly is at in his understanding of fibromyalgia. "It is the feature that is most in need of change, in order that a life of quality, free of pain, fatigue and psychological distress can be attained... The emptiness inside you that was once filled with work, perfection and achievement needs to be filled with something more normal, healthy and fulfilling."
The language of this book makes it most accessible. The thoughts and understandings, while rooted in scientific medicine, underline how far from conventional medical thinking Kelly has travelled in his journey of discovery.
I would like to wish readers a happy and stress-free Christmas and the best of health for 2005.
From the Heart by Patricia Casey; Blackhall Publishing. Fibromyalgia by Michael C Kelly; Kelmed Publications.
Dr Muiris Houston is pleased to hear from readers but regrets he cannot answer individual queries.