Madam, - I find myself once again compelled to comment on an article by Dr Michael Corry in the Health Supplement on Tuesday last. He states that all emotions rely on shifts in chemistry which are always secondary to alterations in our consciousness. This is inaccurate.
All emotions are indeed chemically mediated but shifts in chemistry can also cause significant alterations in emotions and consciousness. For example, hormones alter emotions, endorphins influence mood and anaesthetics render us unconscious. With regard to the importance of thought patterns or belief systems in the understanding and treatment of depression the literature is clear. Whether disturbances in these areas are causal however is still very much open to debate. The literature also indicates the importance of medication in treating a subset of depressions. Ethical practice demands that proper attention be paid to all evidence-based treatments in the provision of adequate service to patients.
Dr Corry also suggests that informing a patient that they have a chemical imbalance which may be lifelong, requiring the long term use of medication and intermittent hospitalisation can be as damning a diagnosis as an incurable cancer and may precipitate suicide. I would suggest that a diagnosis of incurable cancer which is by definition a death sentence is far more serious than a diagnosis of bipolar disorder that responds well to medication if properly prescribed and consistently taken.
Unfortunately, relapses in such instances are often due to cessation of medication on the part of the patient.
With regard to the presentation of such a diagnosis from a doctor to a patient, the clinician is ethically obliged to inform the patient as to their condition and the best evidence-based treatment available to help them.
Of course the clinician may also make a decision as to when to provide the information, but this involves possible postponement, not a failure to divulge. It is important to ensure appropriate supports are in place to facilitate the patient in coping effectively with such difficult news.
Is Dr Corry suggesting that patients not be informed, or is he denying the reality of such cases?
I am somewhat confused as to Dr Corry's position on assessment, diagnosis and treatment in general. In his book Going Mad, co-written with Aine Tubridy, which is referenced at the end of his article, he states that "medicine is on the threshold of an expansion from a mind-body focus to embrace the dimension of spirit. An increasing knowledge of the chakra system, the influence of past life experiences and the place for distant healing is evidence that that expansion has begun" (pg 140).
In my view, medicine is a science and as such must focus on research and experimental validation of its treatment modalities. Chakra systems, past lives and distant healing lie in the realm of fantasy and have no supportable evidence base. The main effect of distant healing has been to relieve vulnerable people of their hard earned cash having no impact whatever on their malaise.
More worryingly, Drs Corry and Tubridy state "we would encourage people to continue searching until the gel is right with either their doctor or their treatment. If the medication is not working, take yourself off to a psychotherapist. If that does not work, go to a homeopath, an energy worker, an acupuncturist or a spiritual healer" (pg 146).
On what basis are these referrals suggested? Certainly not on evidence of efficacy. Such referrals also run the very real risk of putting the patient into the hands of untrained practitioners and charlatans of which there are many in our midst.
I do not doubt the sincerity of their intentions, but I do believe that much of what they have written in Going Mad is mistaken and misleading. The book is replete with pseudo-scientific nonsense and consists largely of statements of spiritual or philosophical beliefs which do little to illuminate our understanding of serious psychiatric and psychological problems. - Yours, etc.,
PAUL O'DONOGHUE.
Principal Clinical
Psychologist,
Woodleigh Elm,
Highfield Road,
Dublin 6.