In the late 1980’s, depression was diagnosed in 1 in 10, 000 people. Now, the diagnosis is at least 1 in 10, perhaps as much as 1 in 4. Why do you believe this has happened and how reliable do you think these diagnoses are?
The rate of diagnosis of few if any medical conditions worldwide has escalated to anything like the degree to which depression has been increasingly diagnosed over the past thirty years. I am not alone in believing that this situation is not as clear-cut as it is often presented to be.
In my opinion, over the past 30 years, many forms and experiences of emotional distress have been increasingly been repackaged as mental illnesses, depression in particular. I believe it is no coincidence that the surge in depression diagnosis coincided with and paralleled the production and availability of the SSRI antidepressant drugs. These drugs (Prozac being the first) became available roughly 30 years ago, and were widely promoted as capable of making feel “better than well” (which itself is not necessarily a natural state). Doctors felt they finally had substances available to them that would help many people. Doctors consequently became increasingly enthusiastic about diagnosing depression, and the ball was now rolling.
As a group unfortunately, we doctors have short memories. We forget, for example, that there has over the past 100 years or more been a recurring scenario, generally taking place over a 25-40 year cycle. This involves the ‘discovery’ of a wonder new drug for mental distress; the rapid growth in enthusiasm for the drug, including rapidly increasing prescribing rates, eventually reaching a peak; the arising of problems associated with the drug, often including dependence and other adverse effects, the presence of which has often been resisted by both the pharmaceutical industry and the medical profession; and a gradual realization (which can take many years, sometimes decades) of the true value (if any) of the drug. Before the SSRIs, there where the benzodiazepines (known as ‘mommy’s little helpers’), whose addiction legacy remains with us to this day. Prior to the benzodiazepines, similar scenarios occurred with other drugs such as the barbiturates, amphetamines, bromide, the opiates, and indeed alcohol. I believe that the majority of my medical colleagues have unwittingly been caught up in the latest of these scenarios – the SSRIs and related drugs.
As I discuss in my books, I have considerable concerns regarding the process of diagnosis and treatment of depression in general. I cannot see how such an explosion in the diagnosis and treatment of depression in such a short time can have a sound scientific basis.
You speak about the ‘mental wellness-illness spectrum’; for people who’ve not come across this term before, can you please elaborate.
I believe it is appropriate to consider emotional and mental health as a spectrum, a range, rather than simply two levels, mental wellness and mental illness. As I see it, mental health itself is very closely related to our level of emotional distress, our level of sense of self. There is a wide range within which a person’s sense of self and level of emotional distress may fall. Some people have a very solid sense of self, experience little emotional distress, and consequently their mental health is in a peaceful and generally calm state. Others experience major emotional distress and have little or no sense of self. A significant number of this latter group will have been diagnosed with major mental health problems such as schizophrenia. Between these two extremes, these two poles, there is a wide range of levels of emotional distress and sense of self. In my experience, the lower a person’s sense of self and the higher their emotional distress, the more likely they will become diagnosed as having a mental illness.
You say that words are very important to you. To what degree can words help the current understanding and misunderstandings around mental health?
How we use words is extremely important. I am a great believer in simple, plain English. If you truly understand something, you should be able to explain yourself in plain English. This applies to doctors as well as to others. Part of the reason there is so much mystery, fear and mystique around mental health is that as a society, plain English is no longer our first language in matters concerning emotional and mental health. We defer instead to medical language, medical jargon, and complex words and phraseology creates an immediate hierarchy, where ordinary people, who cannot be expected to understand medical jargon, that the ordinary man in the street cannot comprehend or access, and is therefore disempowered, albeit unwittingly.
In my opinion the use of medical jargon in mental health frequently muddies the waters rather that bring clarity to the situation. For example, if a doctor truly understands depression, bipolar disorder or schizophrenia, he or she should be able to explain themselves to people in plain English to ordinary people. If they cant, then in my opinion this raised questions about their actual level of understanding. One of the main recurring concerns I have had regarding mental health for the past 15 years concerns the repackaging of emotional distress into various categories of mental illness, as mentioned in an earlier question. It is through the abandonment of plain English and the adoption of medical jargon that this repackaging process occurs. Plain English includes people and promotes equality and transparency. Jargon of any kind may promote exclusivity, and hierarchy rather than equality.
Tell us about your journey to publication: BEYOND PROZAC: Healing Mental Distress and Selfhood: A Key to the Recovery of emotional Wellbeing, Mental Health and the Prevention of Mental Health Problems. Was the experience what you expected and did writing your second publication differ in any way from writing your first?
I qualified as a medical doctor at University College Cork in 1982. I trained to become a GP, and subsequently worked as a GP until the late 1990s. During my years working as a GP, I increasingly came to doubt the soundness of my medical training in the area of mental health. I began to realise that much of what we doctors do in mental health is to reinterpret what people are experiencing, and I became increasingly concerned that the methods of interpretation I had been taught in medical school might not be nearly as reliable in practice as I had been told they were. I had become concerned with what was becoming increasingly clear to me as a considerable lack of true science and understanding to back up the medical approach to mental health.
Once I focused on this, I constantly kept a notepad with me, jotting down ideas whenever they struck me. Gradually the book took shape. My first book Beyond Prozac was first published in 2001 in Ireland, re-published in Ireland in 2005, and was published in the United Kingdom in 2004. The writing process for this book began about 3 years prior to publication, perhaps more. Ten years on, Beyond Prozac has been a best-seller, was shortlisted for the Mind UK Book of the Year Award in 2002, remains in print, widely known in Ireland, and has touched many people and apparently continues to do so. I am humbled and honoured to know that. I certainly didn’t expect anything like the reaction Beyond Prozac received, but this reaction told me something important: that much more such work needs to be done.
I published my second book, Selfhood: A Key to the Recovery of Emotional Wellbeing Mental Health and the Prevention of Mental Health Problems, in 2011. The drive to write Selfhood came from a desire to produce a practical and accessible self-help book for people experiencing emotional distress and mental health problems. The book revolves around one’s sense of self, because over the years I have found this to be a key aspect to emotional wellbeing and mental health (if one has a solid sense of self), and a key aspect of emotional distress and mental health problems (if one does not have a solid sense of self). I wanted to make available a book that would essentially encapsulate how I work, how the process of recovery of self works, and how this benefits our emotional wellbeing and mental health. The recovery of our sense of self is akin to a project, an extremely important project, one that takes time, patience, work, and gentleness. I wanted Selfhood to be a book that people could read, re-read, refer to and learn from, implementing the book contents in real and practical ways in their everyday lives, rather than being a book people read once, said ‘that was nice’, never opened the book again, and having read it, implemented little or no change in their life.
I have been very pleased with the public response so far. Many readers have fed back to me that reading Selfhood it was like reading about themselves. Several prominent UK mental health organisations have spoken highly of Selfhood. While Selfhood is written primarily for individuals, I am very pleased that a prominent Irish psychotherapy journal has just this week published a very positive book review of Selfhood, in which the reviewer wrote “I strongly recommend it as a requirement in (counseling and psychotherapy) training programmes”. Perhaps what pleases me most is that I think I have managed to accurately articulate the issue of self and how it applies to emotional wellbeing and mental health, making it understandable for and accessible to the reader.
You take an all-round approach in your work; medical practice, conferences, radio, publication. What do events like Writers’ Week mean to you?
I am delighted to have been invited to speak at Listowel Writers Week, I consider it an honour. Listowel Writers Week has such a long, solid tradition. I like the breath of books, genres, and speakers involved. It is of the people and for the people, fundamentally democratic, where writers and readers get to meet and mingle, bringing together those who share the love of books, writing, reading, learning, meeting, chatting, dreaming. Wonderful.