This week, by request, I’m posting part 1 of an interview with writer and leading mental health specialist, Dr Terry Lynch. (Please note: this was originally written for Writers Week 2012 by Elizabeth Rose Murray on May 24, 2012)
Why do you think mental health and mental health problems are such difficult areas for society to understand? In what way are attitudes changing in Ireland and across the globe?
There are a number of reasons why mental health and mental health problems are poorly understood within society. As a society (in keeping with most Westernised countries), we have made the fundamental error of judgement of believing that mental health problems are fundamentally biological in origin. This has not been established (for example, there are no physical or biological tests for any mental health problem, because the often-stated chemical and/or neurological abnormalities have not been proven or established). Yet because society’s appointed experts (principally, psychiatry) say that mental health problems are primarily biological in origin, people are at a loss to truly make sense of and understand mental health problems.
What is needed is a revision of our understanding of mental health and mental health problems, to include a far more comprehensive understanding of emotional and mental health, and mental health problems, than currently prevails. A key starting point is to understand why emotional and mental health problems make sense, how they can be understood. Pathologising human feelings and experiences is not necessarily the most productive way forward. It is also necessary to revise what we interpret to be normal and abnormal. This needs to be the platform from which emotional and mental health problems are responded to. In addition, stigma, fear and prejudice surrounds mental health and mental health problems. These issues would become far less and might indeed disappear if, as I outlined above, we had a far more comprehensive understanding of emotional and mental health, and emotional and mental health problems.
Regarding attitudes in Ireland and across the globe, one of the most striking developments in mental health worldwide including Ireland has been the growth of the mental health service user movement. This movement is gathering pace internationally and Ireland. This movement calls for a greater emphasis to be placed on recovery, on greater involvement of the service user in their own care decisions, on alternatives and other options to medication, on having choices, and on human values such as respect and dignity. I hope that this movement continues to grow, in strength and in number. In Ireland, the speed at which mental health policy changes nave been introduced over the past six years has been disappointing, only partly due of the recession
You have a strong focus on mental recovery. What are the main issues you meet as you campaign to raise awareness of mental wellbeing and how do you overcome them?
Strange as it may seem, there is considerable resistance and reluctance to properly address the issue of mental health recovery in Ireland, as in many other developed countries. Mental health recovery was a key recommendation of A Vision for Change, Ireland’s official mental health policy since 2006. I have been involved in A Vision for Change for the past 9 years, having been on the Expert Group on Mental Health Policy (2003-6) that formulated A Vision for Change, and having been on the Independent Monitoring Group (2006-12) that monitors the implementation of A Vision for Change. In each of the past six years, this Group has reported considerable disappointment at the lack of progress on mental health recovery within Irish mental health services.
A recurring issue I encounter is the belief that mental health problems are frequently considered to be life-long; once a person has had a serious mental problem, the presumption is often made that they now have a life long problem. I have regularly found that this often need not be the case. I have repeated found that what is fundamentally emotional distress is frequently misinterpreted, and repackaged, as mental illness. As a society, we really need to re-evaluate how we interpret and package emotional distress as mental illness. I use every opportunity I can to promote a more comprehensive and accurate understanding, of emotional distress and mental health.
You say the science of psychiatry needs to be questioned in detail, asking ‘where is the science to back up this biological of mental health module we operate?’. Where have your investigations led?
In the public interest, as a matter of considerable urgency, the science of psychiatry needs to be questioned in detail. For decades, psychiatrists and GPs have confidently informed their patients that their mental health problems are caused by known brain disorders, most commonly, by chemical imbalances in the brain. These statements have been made so frequently and for so long that the public have generally come to accept this as truth, as gospel. The truth is that chemical imbalances have not been identified for any mental health condition, including depression, bipolar disorder and schizophrenia, despite what you may have heard about serotonin. Yet, no person ever has their supposed chemical imbalance confirmed by any test, ever, anywhere in the world. No such tests exist, because no chemical imbalances have been established. This is misinformation on a grand scale, something which should not be allowed or tolerated, particularly in a modern, well-educated and generally well-informed country such as Ireland.
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.