The drugs don't work - psychiatric guru Ivor Brown says he would never give antidepressents to anyone
Our reporter talks to psychiatric guru Ivor Browne, who says he would never give antidepressants to anyone as they are 'ineffective'. Others in his profession say the advice is misguided and even 'dangerous'. As a new film opens detailing his methods, we explore the answers
For decades, Ivor Browne has been one of the best-known psychiatrists in the country.
Lauded by his admirers like a mystical guru, he has been credited with breaking down the walls of our mental hospitals, and freeing many patients from incarceration.
As a sprightly octogenarian who meditates twice a day and lives in a house named Gandalf - in honour of a character in JRR Tolkien's The Lord of the Rings - he is no ordinary doctor.
One visitor to his home in South Dublin said the white-bearded figure looked like he had walked straight out of the pages of the Bible.
The writer Colm Tóibín, who has attended his therapy sessions, once said of him: "There's an aura off him that is almost holy."
The psychiatrist prompted Tóibín to unleash "unexperienced" pain over his father's death when he was a boy of 12. Tóibín once wrote of how he once lay on a mattress and screamed with grief, having suppressed it for years.
As a psychiatrist, Browne is said to have "dried out" Ronnie Drew of the Dubliners, and there is no shortage of well-known figures who are prepared to endorse him.
Few doubt that he helped to shake up the world of Irish psychiatry over the decades, and shed light on a hidden world of mental anguish. But his views opposing the use of antidepressants are also highly controversial, and are heavily contested by many other psychiatrists working in Ireland today, including those who advocate talking therapies.
The psychiatrist is again in the spotlight as the subject of a documentary, now showing at Dublin's Irish Film Institute. It not only tells the story of Browne's life but also lifts the lid on our attitude to mental health and depression. Browne tells how when he started as a medical student, doctors were giving residents of mental hospitals lobotomies.
He recalls how he helped in operations, where holes were drilled in patients' heads. A knife was inserted to sever the frontal lobes of the brain.
Browne sought to close the often inhumane institutions that house those with mental illness and wanted to integrate the patients into the community.
He acknowledged that this was only a partial success, and believes that many people out in the community are now institutionalised by heavy drugs.
The semi-retired former professor of psychiatry at UCD this week reaffirmed his view that there is a vast overuse of antidepressants in Ireland.
The debate over antidepressants is of concern to tens of thousands of people. The mental health support organisation Aware estimates 450,000 people are affected by depression in Ireland, the equivalent of one in 10, at any one time.
It is hard to quantify the number of prescriptions for antidepressant pills in Ireland every year, but Browne says if he was writing prescriptions nowadays he wouldn't dream of giving an antidepressant drug to any of his patients. He claims they are "highly habit-forming and difficult to get off".
"I think they are ineffective. They can give temporary relief but they don't achieve any far-reaching results," he tells Review.
It is a long-held view that inevitably makes Browne the target of criticism and out of kilter with the psychiatric establishment, particularly in cases where patients may be suicidal.
Browne, himself the former chief psychiatrist at the Eastern Health Board, emphasises that he is not totally against the use of drugs when treating patients. He says he would prescribe antipsychotic medication in cases of acute psychosis.
That is where a patient loses grip on reality, and may suffer severe hallucinations or delusions. As Browne puts it: "It's what in ordinary parlance we would call 'mad'. Otherwise I would not prescribe medication because I think it's better to work with people's difficulties, to help them discover the source of their problems," he says.
"In my experience, medication makes it more difficult to deal with the underlying reasons for depression."
So if the drugs don't work, in his view, what would he recommend as the best treatment for depression?
"I would say, in broad terms, effective psychotherapy. If you can work on the person's life story, and more specifically deal with any traumas people have suffered from the womb through birth, or in later development, you will make more progress."
Browne says the deepest trauma of all is to be rejected or not wanted by a mother or father, or both.
The psychiatrist has often referred to his own complex relationship with his father, and a form of rejection from the time of his birth. Brought up in Sandycove at the southern tip of Dublin Bay, he regularly heard his father suggesting within his earshot: "I'm afraid Ivor was a mistake. I don't know if I'll ever be able to educate him."
He has told how that his parents, wishing to have only two children, used an unorthodox form of birth control in which his mother kept the bedroom door locked. But Ivor, the third child, was conceived when his father crawled in through the window.
"I was seen as something of a problem and not the full shilling."
His critics have suggested that depression is not always caused by trauma that can be uncovered by delving into the past. They point to those who suffer the condition without abusive incidents, hidden grief or neglect.
"I agree that depression is not always down to trauma," says Browne. "Bipolar disorder (previously known as manic depression), for instance, was recognised right back through the history of psychiatry as involving a genetic component but also involved the person's life story."
He says some people have a natural tendency to such disorders but before the use of drugs became prevalent the incidence of this was rare.
"I would say that too much emphasis is placed on giving medication before exploring the person's life story and any traumatic events as part of this."
While those who have been treated by Browne are full of praise, is an effective talking cure really available for ordinary punters across the country suffering severe distress? Not everyone has access to a therapist of his calibre.
Browne is concerned that virtually anyone can set themselves as a psychotherapist, but believes the field is becoming more regulated now, especially at an EU level. He says treatments such as regression therapy, where patients go back through the subconscious memory to try to confront and tackle forgotten childhood incidents or traumas, require specialist skill.
"The 'talking cures' are not effective where the psychotherapist has not had proper training."
Browne has often been prepared to go out on a limb during his career, and has attracted controversy as a result. In the 1990s, after it emerged that his patient Phyllis Hamilton had had a child with the high-profile priest Father Michael Cleary, Browne spoke out publicly with her consent to confirm her story. He was censured by the Irish Medical Council for breach of confidentiality, but the council rejected the charge that he had failed to act in the best interests of his patient.
It was a sign of a changing country that the council attracted as much criticism for its judgment as Browne did himself.
Browne now attributes growing dissatisfaction and depression to the changing nature of our society, and has said it is hardly surprising that people are unhappy when they spend eight hours at a computer screen and two hours driving in a day.
He likes to quote the Indian philosopher Jiddu Krishnamurti: "It's no measure of health to be well adjusted in a profoundly sick society."
The Wonder Eye: Meetings with Ivor opened at the Irish Film Institute, Dublin last night