Madam, - Having read the letter from the group of six professors of psychiatry in response to the piece by Breda O'Brien, "The Minister's View On Mental Illness," I do not share the view that the Minister's remarks were "downright irresponsible". I feel obliged therefore, to enter what is becoming a national debate on the nature of mental illness.
It seems an obvious thing to say that from before and after birth to adult death, human beings experience things that cause them suffering, but this is a fact of life that is overlooked. Some can bear more than others, some understand more than others; but suffering is a part of life and may become so unbearable that we want to fix it. At that point we look for help, usually from a doctor, and often find that our feelings are called "mental illness". There is such a thing as mental illness, of course, but not all sufferers are mentally ill.
Because of the mechanistic attitude which has accompanied the enormous advances in science and technology, the Western mind has fallen into the illusion that there is a remedy for every ill. The belief has grown up that it is the doctor who cures. The body is seen as a machine with which something has gone wrong, and the doctor's job is to fix it.
Similarly, we have tended to fall into the error of thinking that the therapist cures the patient. When applied to psychotherapy, or to psychiatry generally, this is an erroneous notion. In dealing with psychiatric illness there is no treatment which you can apply to people which brings about real change in them. People have to undertake the work themselves and this is involves pain and suffering.
The only lasting positive change anyone can make is within him/herself. The deeper the change to be accomplished, the greater the amount of pain and suffering involved. People resist change for this reason, even when they realise that change will be positive.
By giving tranquillisers and relieving symptoms, something has been achieved temporarily. But no real change has taken place, and sooner or later most people will have a recurrence of their symptoms with the added burden of the side-effects which most drugs inflict. Many drugs are useful on a temporary basis but are not treatments for specific "psychiatric diseases". However, no psychiatrist who deals with the full range of psychiatric disturbance could manage without them. The question is whether they are given as a treatment themselves or as aid to working in psychotherapy with the person. Often the drug is the only way of facilitating the initial contact so that therapy can begin.
It is not the drug, it is the message which accompanies the drug which is really damaging. Typically, if a person is "clinically" depressed they are told that whenever they feel a depression descending on them they must contact their psychiatrist and commence the appropriate medication. It is because of this, more than anything else, that many people are gradually entrained into a pathway of illness. Perceiving themselves as "ill" and helpless, they move into a state of chronic ill health.
Clusters of symptoms tell one little about the cause, or the natural history, of these so-called "disorders". They have a more ominous significance however, for once you can name symptoms as a "disease" you have created an apparent reality. Then, if you have a specific "disease", due to some, as yet unidentified, underlying biochemical abnormality, there should be a "specific" remedy to deal with it. This suits the pharmaceutical industry perfectly. Unfortunately, most psychiatrists have taken this great falsehood on board.
All that drugs can do is to temporarily reduce symptoms, making life bearable. No drug can teach you what you need to know to manage life or have a personal identity. Often in life we cannot see how we got to where we are, or why we continue to make the same mistakes no matter how hard we try. If a person could undertake whatever change is necessary to manage their life successfully, there would be no need for a psychiatrist or therapist. Of course, the person who comes to our aid need not be a professional; indeed, a great deal of helpful intervention is carried out by self-help organisations such as Alcoholics Anonymous, Grow, etc. but in many situations a friend is not enough and the objectivity and understanding of a person with experience and training is necessary.
Finally, I return to the fundamental principle that it is people themselves who have to undertake the work if they are to bring about any real change in their lives. If what we are attempting to change is ourselves, our deepest personalities, then this can be painful indeed.
If the person who is "mentally" ill is not prepared to suffer, then, to put it bluntly, you can have all the skills and training and be the most experienced psychiatrist, but you will be absolutely helpless to do anything for them. - Yours etc,
IVOR BROWNE, (Professor Emeritus, University College Dublin), Ranelagh,Dublin 6.