Madam, - Since Breda O'Brien saw explicitly and disparagingly to comment both on me and my book Beyond Prozac (Opinion, November 25th), please afford me the opportunity to reply.
Ms O'Brien admits that 80 per cent of the letters she received in response to her previous article "Minister's view on mental illness dangerous" (November 11th) did not support her views. Considering that six professors of psychiatry enthusiastically endorsed her (November 16th) and suggested that the Minister of State with responsibility for mental health should consider his position, an 80 per cent disagreement rate is striking. This should be food for reflection for Ms O'Brien and the six professors.
Undaunted, Ms O'Brien last Saturday listed the legitimate concerns raised by the public in their letters, and then proceeded to ignore them. Apparently, she had a far more important task to undertake - to comment on me and my book Beyond Prozac.
Ms O'Brien is "fascinated by those who refuse to countenance that there could be any underlying physical cause for depression". If she is including me in this, she is grossly mistaken. As I have outlined in Beyond Prozac and elsewhere, I am open to the possibility that there may be physical causes for depression and other mental health problems. I also recognise the obvious common sense in the idea that mental health problems may be multifactorial in origin, and that responses need to be comprehensive and holistic.
But unlike many of my medical colleagues, I am not prepared to presume with certainty that there are physical causes for mental health problems until such time as they have been adequately and reliably identified and understood - a situation which is far from the current state of play. In the meantime I will keep an open mind as to any future identification of biological causes of mental health problems such as depression, schizophrenia and bipolar disorder. Furthermore, I do not allow myself to confuse correlation with causation, as some of my colleagues do. This very important issue is outlined in detail in Beyond Prozac.
Perhaps Ms O'Brien failed to understand these matters. I support a balanced approach to research, including biological research, into all possible causes of (and responses to) depression and other mental health problems. The future direction of mental health should not be a simplistic battle between medication and counselling, but rather an enlightened, comprehensive holistic approach, with a wide range of appropriate interventions being available,and with the person's needs, views and best interests being central.
If Ms O'Brien is suggesting that I "discount" the "testimonies of every person who found medication helpful", she is again grossly incorrect. I fully acknowledge that some people find medication helpful. I have said so on many occasions. Indeed, Ms O'Brien herself acknowledged that I do prescribe medication, something I would hardly do if I felt it had no benefit.
Although she does not outline why, Ms O'Brien finds it "interesting" that I wrote to The Irish Times (November 18th) in response to her original article. Apparently, I "rushed" to write in "defence of the Minister". We live in a democracy. Like all citizens, I have the democratic right to express my views. In the past I have spoken out, and I will continue to speak out when I feel it is important and right to do so.
Surprisingly, Ms O'Brien apparently cannot seem to get her head around the fact that I prescribe medication "despite [ my] declaring that there are inherent dangers in all drugs". Perhaps she might feel more comfortable if she could package me neatly into a box, as a doctor who is prepared to see only one side of the equation. Every prescribing doctor knows - or should know - that there are inherent dangers in all drugs. Did it not strike Ms O'Brien that it might actually be a good thing for a doctor to be very aware of the inherent dangers of the drugs that he/she prescribes?
I have never stated anything remotely like her comment that I have a "100 per cent success rate" in working with people experiencing mental health problems. Nor have I stated that people diagnosed with eating disorders, addiction, schizophrenia, depression, bipolar disorder "all apparently respond successfully to [ my] approach in a relatively short time". Nor have I ever stated that I alone "can always judge when such medication is justified". Had she bothered to take the trouble to speak to me before launching her tirade, Ms O'Brien may have found that such arrogance is not part of my make-up.
The tone of her column was in sharp contrast to an excellent article in the Irish Times Magazine of the same day, in which Roisin Ingle addressed similar issues. Ms Ingle's article exuded humanity and openness to dialogue, qualities which are essential if we are to work successfully towards providing more effective responses to mental health problems. Ms Ingle successfully got her point across without resorting to confrontational, aggressive or disparaging language or style.
Finally, I am unclear as to why Ms O'Brien believes that letters from people who are prepared to engage with, challenge, and disagree with the six professors of psychiatry should be described as "abuse". - Yours, etc,
Dr TERRY LYNCH, Member, Expert Group on Mental Health Policy 2003-6; Member, Independent Monitoring Group for A Vision for Change 2006-8; Member, HSE Expert Advisory Group on Mental Health 2006; Ballykeeffe, Limerick.