Tuesday 16 July 2019

'I don't think regulation and prohibition is the way' - Irish psychiatrist Brendan Kelly warns against 'scape goats' for mental health

Donal Lynch talks to the Dublin psychiatrist Brendan Kelly

Prof Brendan Kelly with Trixie at his home in Dublin. Photo: Frank McGrath
Prof Brendan Kelly with Trixie at his home in Dublin. Photo: Frank McGrath
The Doctor Who Sat for a Year by Brendan Kelly is published by Gill Books, €16.99.

Asking a psychiatrist about his emotions and motivations feels a little forbidden. True, Prof Brendan Kelly is sitting opposite me rather than lying on a couch - it's a myth that they all have couches - but it is rather as if the dentist offered you a go with the drill.

For both of us this is clearly a little uncomfortable. "Some people want to rummage around in their soul, to tell a story, to shape it and polish it, in the hope that it will help them in the present," he tells me at the beginning of our chat. "That can be helpful to some, but I'm not one of those people."

But I am, and this (*assumes Clarice Starling voice*) is quid pro quo, Dr Kelly. I'm interested in the man behind the often provocative, always compelling contributions to our national discussion on mental health.

On everything from the suicide rate (which, contrary to popular belief, is not really rising, and compares well to other European countries, he points out) to our cultural resistance to taking antidepressants (illogical, when we liberally self-medicate in many other ways, he notes) Kelly has helped to explode myths around mental illness in Ireland.

Now he's written a book on meditation, The Doctor Who Sat For A Year, which takes the form of a diary on his own year-long attempt to learn how to meditate and cultivate a Buddha-like sense of inner calm.

Throughout he gives accounts of the voluminous number of movies he watches - he goes to several a week - and his mild frustrations with himself.

His mascot for this journey is his cat, Trixie, whose Zen-like presence serves as an example of what might be possible for her human owner.

But even Trixie has her wild moments. In the book Kelly is horrified when she returns, or he remembers her returning, with the corpses of small birds. He tries overfeeding her and putting a bell around her neck but nothing works.

Curiously, the Sphinx-like peace and the occasionally bloody paws seem to go together.

Kelly says the primary benefit of the year of meditation was a greater awareness about his own negative emotion - mainly a sometimes irrational feeling of irritation - but he smiles when I ask him if he, like Trixie, has ever been driven by appetites more than spirituality and intellect.

"That is a very, very interesting question. I think 'no' is the answer. One concern I have is that my life has been very linear. It's been very much along predicted lines, aside from meandering academic interests which came while I was already working full-time as a doctor. That could scarcely be called wildness. I never threw it all in."

In his conscientiousness, intellectual rigour and horror at domestic feline carnage there is something of Walter Berglund, the protagonist of Jonathan Franzen's Freedom, about Kelly.

But while Franzen called Walter "a portrait in the displacement of unspeakable rage" Kelly says he does not now, nor did he ever, feel real anger.

"I do toss about on the emotional sea but not to the point where it causes me distress," he explains.

"All of my emotions are within the normal human bandwidth. I don't get angry, I'm very much a no drama person. I do feel irritation but apparently it's imperceptible to anyone I ever meet."

He grew up in Galway where his mother was a teacher and his father worked in business. He had two sisters. Family life was, he says, marked by an unusual lack of conflict or instability. In school he was a quiet, studious boy who did not play sports but somehow managed to avoid being bullied. His only source of confusion through his whole puberty, he says, was what he would do after school. Half way through his Leaving Cert year he abruptly switched from business subjects to science ones and traded aspirations of becoming an economist for a determination to study medicine and pursue psychiatry. It was the openness of the field which attracted him, he says.

"Psychiatry is the only medical discipline where you have professionals in it arguing about whether mental illness really exists; you wouldn't get that with cardiologists and the illnesses they treat. The need for psychiatry was huge but the field itself seemed quite ill-defined and open."

He graduated in 1996 and spent one year as a medical house officer in Galway before taking up research posts in Dublin. He is a polymath, taking in degrees in other disciplines along the way: a masters in healthcare management, another in epidemiology, a course in Buddhist studies, followed by PhDs in history and law and a doctorate on governance in Queens University Belfast. He has been a consultant in Tallaght hospital for the last three years; before that he was 10 years in the Mater.

He met his wife, Regina, at medical school. She is also a doctor and they married in 2004. They have two children together, Eoin (13) and Isobel (12).

If his life was marked by an unusual lack of any colourful conflicts or difficulties, this may explain why he was so fascinated with the tribulations of others - the book is full of colourful descriptions of his patients' problems. From his earliest career he was most interested in the patients who were most difficult to treat.

"If there isn't difficulty to work through, a certain amount of frustration along the way, then perhaps one should be doing something else," was his guiding idea.

"I am very interested in treatment resistant schizophrenia," he adds. "Most of the world doesn't know the extent to which these patients (who have this condition) struggle and have difficulty."

Given his own unshakable equilibrium I wonder did he ever have trouble relating to the great struggle these patients encountered - but relating is beside the point, he says.

"The most useful thing with patients is being entirely and directly honest. For instance, if they ask me if I've been depressed I have to truthfully say, no, I've felt sad but nothing like what you are going through; can you tell me what it is like for you?"

He says the calmness he cultivates in his now-daily meditation is helpful when confronted with the extremes of human emotion.

"Someone can come to you and they may be thinking of killing themselves or hearing voices, that, on a level, they know that nobody else can hear. That is terrifying to them and the key message that I can give them is not in words but in my calm demeanour which demonstrates that the thing that is overwhelming them isn't overwhelming me."

What about when patients he has treated have died by suicide?

"You do think about what you did and what you said. You go over all the treatments you offered. Were they enough? Were they not? You wonder to what extent the system, the number of psychiatric beds in the country, affected your decision. It's a difficult situation for sure but it doesn't stop me from moving on, from trying to help the next person in the line."

Psychiatrists are often considered the last bulwark of preventing people from committing this terrible act. Has he ever encountered hostility from bereaved families?

"There can be differences of opinions within families about whether we helped enough. Often if a family member has accompanied the person who has died to their appointments with me, they are more open to the idea of us attending the funeral than those who didn't walk the walk. But we never want to cause conflict within families. I have dealt with hostility in that scenario, but not as much as you would think."

Suicide rates in this country may be falling but they remain alarmingly high for young men in particular. Why is this?

"We don't know. Rates are falling but the rate of suicide of young people in Ireland is still far higher than the EU average. There is no doubt that Irish society is failing its young people in some key way - no person is born wanting to die - but I do not know for the life of me why this is happening. Our goal needs to be zero."

It's important, he says, not to reach for the wrong scapegoats.

"Social media may be part of the story but it's important not to blame it. It's up to adults like me who grew up without social media to understand it and not simply pour scorn on it. I don't think regulation and prohibition is the way to go because human beings respond to bans by becoming more interested in the thing that is banned. The moral talk about social media is the exact same as the one that was previously had about television."

He says there is a pressure in this country to 'medicalise unhappiness'.

"People often come with a series of life problems that are making them very unhappy but they don't have what we currently call depression, by which I mean that our current treatments for depression are unlikely to help them with their life problems. There is an enormous demand for antidepressant prescription from a certain cohort of people - contrary to what you read in the media - but then there are other people who are more hesitant to take the medication. Our antidepressant prescription rate is less than 50pc of that in the North and our sedative rate is less than 40pc of that in the North."

The mental health benefits of meditation are huge, but when I point out that all the biggest mental health gurus (eg Eckhart Tolle or Byron Katie) began their journey with a crisis he says that it's a mistake to think you need this, or indeed any sort of profound unhappiness, to have the motivation to change.

"A lot of people get the impression that they're overwhelmed by all the things we should be doing. Sometimes there is so much to do I find it hard to just be and sit.

"For someone starting out the key is simple and sustainable. Meditation gives you a sense of control and mastery that you can clear a little space in the thicket. Giving up coffee would be the same demonstration of willpower but it wouldn't give you the same feeling of settledness."

And after the uphill struggle of daily practice is he now as serene as Trixie?

"I don't know", he begins. "Maybe I have all of these subconscious dead birds and mice somewhere inside me. I think I was up to this point a very stable person."

I look at my watch. Our session is up.

'The Doctor Who Sat for a Year' by Brendan Kelly is published by Gill Books, €16.99.

 

Myths about mental health in Ireland 

1. Too many of our kids are on Ritalin

"We don't have an honest conversation about ADHD in children. It tends to generate these hugely emotional responses. There's this idea in Ireland that the rates of Ritalin prescription are really high here but in fact they're low by international standards. In the US in certain areas up to 40pc of kids are on Ritalin, which is way too much.

2. People are right to be wary about medications like antidepressants

"If you lined up alcohol, which is commonly used to self-medicate, beside other prescription medications, I guarantee you the alcohol would be stronger. We see people who are hesitant about anti-psychotic medication but they'll go and take crack or heroin. We agonise about small changes in dose (of prescription medication) but then we might have five pints one day, four the next and none the next."

3. The repetition of the mental health conversation in celebrity interviews has dulled the message

"We always seem to be having a conversation about mental health and a lot of people will ask 'when is having a conversation no longer enough'. But every time a new sports personality or celebrity talks about, say, anxiety or depression, there are thousands of people out there who are hearing that discussed for the first time."

 

Brendan's top tips for meditation

1. Commit to meditate today (and only today)

It is not necessary to commit to meditating tomorrow or to meditating every day for a week, a month, or a year (as I did, possibly foolishly). Overcommitment is a recipe for procrastination. If you have opportunity to meditate today, meditate today. If you have opportunity to meditate tomorrow, meditate tomorrow.

2. Find a quiet-ish place (but do not obsess about silence)

Do not obsess about finding absolute silence. You'll never find it. Just find a space away from the hustle and bustle of everyday life. There will still be sounds: cars passing, clocks ticking, birds singing, your stomach gurgling. Just note the sounds, let them pass and allow your mind to settle.

3. Sit however you wish (there are no absolute rules)

There are thousands of meditation postures in use around the world. You just need to find one that suits you. If none of the described positions suit you, simply make one up. In general terms, it is important that your body is straight and relaxed, your spine upright and that you feel stable and grounded.

4. Try to let your mind settle (by viewing it from afar)

Clearing your mind is both a technique and a goal of meditation. The best way to dispel the cluttered clamour of your mind is to try to detach and view it as if you are an observer looking through a telescope from outer space. Focus on your breathing instead.

5. Be grateful for distractions (they are why you're here)

Once you try to clear your mind, it will fill immediately with a dozen different thoughts, all competing for attention. Good. This is precisely why you are meditating. If you were able to sit in a state of pure mental clarity, you would not need to practise meditation! Try to observe the thoughts from a distance, and simply let them pass.

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