Medication has a role in modern psychiatry

In a debate hosted by Maudsley hospital in London last June, consultant psychiatrist Adrianne Revely told a chilling story.

A man was convinced that his dead twin was watching him from his hand. The therapist to whom he was referred belonged to the anti-psychiatry movement, and believed that this was not evidence that he needed medical treatment or hospitalisation, but instead was his way of coping with his brother's death.

With adequate psychological support, the delusions would resolve themselves. Shortly afterwards, the distressed man cut off his hand.

Since I wrote about Minister of State at the Department of Health Tim O'Malley wondering aloud in the Irish Medical News whether depression and mental illness were medical conditions or not, my inbox has been pinging on a regular basis to announce the arrival of yet another passionate e-mail on the topic.

Some of the e-mails were three times the length of this article. They ran roughly four to one in favour of the Minister. They could be summarised as follows: there is no blood test, or any other physiological test that establishes a biological basis for mental illness.

Depression can cause biological symptoms, but not the other way round. Drug companies are intrinsically corrupt, are only interested in profits, and regularly sponsor research that is published under the name of eminent doctors who had nothing to do with the research.

Drugs are dangerous and addictive. There is little or no evidence that they work any better than placebos. The side effects far outweigh any dubious benefits.

Psychiatry is attempting to present itself as scientifically based and a valid branch of medicine, but it is no such thing. Depression and other conditions categorised as mental illnesses are understandable reactions to severe emotional stress, not medical conditions. When a therapeutic relationship is established which values the person in distress and helps to raise their self-esteem, they can recover fully.

Some correspondents are completely against medication. Others allow it a very small, short-term role, but emphasise the therapeutic relationship above all else.

The Minister has since distanced himself from his original comments and presented a much more mainstream view in the letters page of this newspaper.

Mind you, it is also interesting to see who rushed to write in his defence. For example, Dr Terry Lynch calls him an "excellent Minister".

Dr Lynch, in his book Beyond Prozac, claims to be able to enable people to recover from schizophrenia simply by developing a relationship of trust with them and engaging with the underlying meaning of their symptoms. Perhaps Dr Lynch should be the subject of research himself, since in his book he appears to have a 100 per cent success rate.

Eating disorders, addiction, schizophrenia, depression, bipolar disorder - all apparently respond successfully to his approach in a relatively short time. He does use medication, despite declaring that there are inherent dangers in all drugs, and that Prozac, for example, is addictive. Apparently, he can always judge when such medication is justified, unlike psychiatrists, who are blinded by their dependence on a biomedical model.

It might shock Dr Lynch to discover that I agree with quite a few of his ideas. It is true that we are living in a world where normal unhappiness is becoming medicalised.

Medication is over-used, and people's emotional distress is often ignored. It might shock him still further that the six professors of psychiatry, who came in for a fair share of abuse for their call on the Minister to consider his position, also agree that depression and mental illness are frequently diagnosed wrongly.

For example, Prof Patricia Casey has written about the need to carefully distinguish between "an understandable but exaggerated response to a stressful event", and major depression. The former will resolve itself "when the stressor is removed or when a new level of adaptation is reached".

It requires no intervention except support, or medication for the relief of symptoms, such as short-term prescription of sleeping tablets.

She is critical of the fact that "transient depressive responses to stressful events are increasingly regarded as illnesses requiring specific intervention".

Her approach could hardly be described as dogmatic, or as close-minded adherence to a biomedical model. Dr Lynch parts company with Prof Casey in that he apparently believes that all depression and mental illness can be categorised as a response to severe emotional stress.

I am fascinated by those who refuse to countenance that there could be any underlying physical cause for depression. It seems to me that the mind and body are so intimately linked that this position is closer to dogmatism than the positions ascribed to the professors of psychiatry. It is a dualistic standpoint, despite claims to being holistic, because it demands such a sharp division between the physical and the psychological.

While the anti-psychiatry advocates point to the side effects of medication, they often refuse to acknowledge the side effects of inappropriate use of counselling.

One does not have to resort to the unfortunate man who cut his hand off. As a writer for this paper, I have heard many accounts of people becoming dependent on counsellors, or experiencing severe relapses when advised by counsellors to come off medication.

What about the side effects of untreated depression and mental illness? The prospects for people with schizophrenia get more and more bleak, the longer it is undiagnosed and untreated. Why are the testimonies of every person who found medication helpful all discounted? For example Lewis Wolpert, the eminent professor of biology, credits his recovery from major depression to appropriate use of medication, as did the writer William Styron, who moved from being suicidal to a decent quality of life.

Perhaps they are ignored because their testimony does not suit those convinced that only psycho-social factors matter.

Psychiatrists use a range of therapies, and are constantly calling for funding for multidisciplinary teams who can provide a wide range of interventions. Our mental health services are in many ways inadequate, mental illness is often diagnosed wrongly, medication is by no means a panacea. Yet in spite of all that, many people have a renewed and happier life today because of the advances of modern psychiatry, including medication.