Tuesday 12 December 2017

No Ivor Browne, one size does not fit all when dealing with mental illness

Dr Ivor Browne. Photo: David Conachy
Dr Ivor Browne. Photo: David Conachy

Patricia Casey

I listened with great interest to the interview with Professor Ivor Browne on Sunday with Miriam recently. I agreed with some of what he said, I was dismayed by other comments, and his introductory remarks made me understand his preoccupation with and sensitivity to childhood trauma.

I completely agree that medications, especially antidepressants, are overused. There are many people who carry the label of "depression" and see themselves as ill, when in fact they have had terribly sad lives due to childhood neglect, abuse and poverty.

Antidepressants are not appropriate for desolation and despondency. These emotions are not usually indicative of illness, but a response to a real-life situation. Such people need support and help in manoeuvering life's quagmires, together with growing in self-value and confidence. Achieving this is more difficult that it seems.

Regrettably many people born into loveless and abusive families lead chaotic, drug-filled lives and trying to engage with them in therapy is challenging due to self-harm and unbridled anger. There are national services now available for those whose problems have stemmed from childhood abuse, and the psychologists working in them provide excellent help.

Even some people with short-term stressors such as a relationship that is crumbling, or those who are in serious debt, are often inappropriately prescribed antidepressants. I have no issue with Professor Browne on this either.

What alarmed me was his statement that he never prescribed antidepressants, and that they prevent the person addressing the underlying deep trauma that lies within. When pressed by Miriam that some people derive great benefit from this medication, and she pointed to the studies showing benefit, he opined that he dismissed it.

So how does a depressed person engage in therapy if they are immobilised by gloom? What if the person believes they are evil and try to end their lives to make the world a better place? Would he give them an antidepressant?

The first suicide I dealt with as a trainee psychiatrist was a man who believed he had committed a murder and gave himself up to the police. He was brought to hospital and jumped out of the window on his first night.

Professor Browne's belief that scientific studies are in some way "bogus", was astounding and dangerous. He was expressing an opinion that flies in the face of all the contrary evidence. What is his reason for making this wild claim? He also challenged the reality of bipolar disorder, except for the very few. He is correct to the extent that some believe they have bipolar disorder when in fact they do not and there is evidence to support this. But this disorder is more common than Prof Browne's comments would allow one to believe. He did not indicate if he was willing to use mood stabilisers for this. In fact the lifetime prevalence of bipolar 1 disorder (formerly manic-depression) is 1pc and 1pc also for the milder, but nevertheless incapacitating, bipolar 11 disorder.

Prof Browne mentioned childhood trauma many times and said it could begin even in utero. His belief seems to be that this is what needs to be addressed in therapy for virtually all of those with mental illness. But this perspective is excessively narrow.

I concur that people who are traumatised need to deal with this, but the brain is a physical organ too, and it can become damaged at a molecular level just like any other organ in the body.

In these instances the result is a psychiatric illness needing physical treatments with medication.

Trauma is not ubiquitous nor are they present in every person with a mental illness. Prof Browne brings a perspective that may be tinged by his own unhappy beginnings. I do not know why or how he has come to the belief that antidepressants prevent psychotherapy. The two are not mutually exclusive.

If you have doubts about your antidepressant medication and its appropriateness for your particular condition, by all means question it, but do not discard it because of the opinions of one person. Best medical practice should be based on evidence and in relation to bipolar disorder and most cases of depressive illness the evidence is contrary to what Prof Browne is advocating.

The claim that doctors do things to people and that only people can help themselves, is mistaken.

What if the person is mute due to severe depression? People who are ill have a right to treatment and unless one disregards the reality of mental illness, as Prof Browne seems to be doing, this right should remain.

Finally, Prof Browne is deeply misguided in his narrow approach that sees all psychiatric disorders as stemming from childhood or other trauma.

No, one size does not fit all, and all good doctors should have the armamentarium that includes talking, social and pharmacological therapies used in combination or alone according to need.

This is what a truly holistic approach to psychiatric illness entails.

* A documentary on Ivor Browne Meetings with Ivor is now showing at the IFI, Dublin 2

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