Wednesday 23 January 2019

Most people labelled as having depression have suffered grief that hasn't been resolved

Irish prescriptions for antidepressants, close to 450,000 annually, are "very much a creation of psychiatry" says Professor Ivor Browne. He tells Kate Shanahan there are no instant solutions to problems that reflect a deeper hurt

Professor Ivor Browne with Kate Shanahan
Professor Ivor Browne with Kate Shanahan
Ivor Browne at his home in Ranelagh, Dublin. Picture: Caroline Quinn
Professor Browne supported Phyllis Hamilton, pictured with Fr Michael Cleary and their son Ross

Professor Ivor Browne tells a story against himself which, though pithy, reflects in its own way his dissonance from the psychiatric establishment. Two medics meet and one tells the other about a particular case, the punchline being, "and guess who they brought in as an expert, Ivor Browne… sure that fella's mad".

He laughs himself at the retelling, not at all discommoded by the fellow professional's dismissive stance. Browne's highlighting over the years of the rights of patients, his support for Phyllis Hamilton, Fr Michael Cleary's partner, and his willingness to go against the popular medical consensus on some issues, has gained him a reputation as a maverick.

But many of the concerns he has expressed are now mainstream. In the US, in particular, discussions on the role of treatment and drug prescriptions have become part of a fresh wave of debate between academics and researchers on mental health.

On the one hand, there are those campaigners like Peter Gosche who believe that the psychiatric establishment has been corrupted by its close links with the pharmaceutical industry, and that the theory of chemical imbalance has never really been proven.

On the other, there is the view of many clinical psychiatrists, as espoused by Cornell's Prof Richard Friedman, that they "are helping people with life-threatening illnesses at high risk of suicide who have impaired functioning. And they are the patients for whom psychotropic drugs can be life-saving. "

Ivor Browne at his home in Ranelagh, Dublin. Picture: Caroline Quinn

Professor Ivor Browne

Somewhere in between is the middle ground, as put forward by Peter Wehrein writing on the Harvard Health blog that "depression was neglected, and sometimes antidepressants are the remedy, but there is some overuse and that has been a major factor in the 400pc increase in the US (between 2005 and 2008)."

At the age of 86, Ivor Browne is firmly on the side of those like Prof Peter Gosche, who believe the drugs industry is out of control.

He still sees patients for a few days per week. Many of those he sees want to come off prescription drugs.

As someone who has spent years at the forefront of psychiatric treatment in Ireland, his views on our current malaise remain trenchant.

The fact that more than 330,000 people each year need antidepressants in a country with a relatively small population does not come as a surprise to him.diagnosis

Of the numbers of prescriptions, which could be close to 450,000 annually, he says: "I believe it's very much a creation of psychiatry and I suppose, our present society."

While he agrees that the increase could be part of higher diagnosis rates, he also argues that there are other factors at play in relation to young people in particular.

"They are not fools, they have all kinds of pressures, and they know that there's something not very good coming out of the other end. Even if you get a degree, you're facing emigration - that's a comment on the sort of society we've created."

He uses a favourite quote from Jiddu Krishnamurthi to illustrate his thinking, "it's no measure of health to be well adjusted in a profoundly sick society", adding "that would be my feeling on our present society - this whole emphasis on competitiveness, capitalism".

"How can you be healthy or happy if you spend eight hours on a computer screen each day and two hours driving there in your motor-car? It doesn't surprise me that people are feeling dissatisfied and depressed."

Professor Browne supported Phyllis Hamilton, pictured with Fr Michael Cleary and their son Ross

Professor Browne supported Phyllis Hamilton, pictured with Fr Michael Cleary and their son Ross

We have a society, he says, that specialises in creating stress, something he attributes to "the constant emphasis on creating profit".

But he is also highly critical of the rush to seek instant solution to problems that reflect a deeper hurt.

"There's a deep misunderstanding which has come in from medicine that the doctor treats. In other words, to treat a person, you initiate a change in their feeling. To my mind, that's an impossibility - the only real change is the work a person does on themselves."

He equally believes that there's a tremendous amount of trauma in life. "Most people who have been labelled as having depression, you'll find if you go back in their lives that they have suffered grief.

"They've suffered grief that hasn't been properly resolved, or in some cases they have family problems, that's often the most severe, there's no love in the family." counsellors

Pointing to the growing numbers of counsellors and therapists, psychiatry has, he says, moved away from the emphasis on psychoanalysis, which had been part of his own early training.

The changes in how patients are dealt with he attributes to the fact that decades ago, the kinds of pills being prescribed now did not exist and that "psychiatrists have moved more into a siege mentality where we can prescribe drugs for people, we can incarcerate people when they're out of control".

He is also wary of the increase in the number of conditions now being classified as a form of mental illness.

"My main difference with the general run of psychiatry is that, personally, I don't believe in these labels. And I think you have to deal with the human being and the human life problems."

He cites the example of those who are being diagnosed as bipolar. "Every third person who comes to me now is labelled bipolar.

"If you looked back, that was once considered a rare condition and what's more, most people eventually recovered. Personally, I won't prescribe an antidepressant for anyone."

Many of the patients he treats, he says, are on four or five different forms of medication, which they have to be weaned off of slowly. Retired as a doctor, these days he "simply works as a psychotherapist," he explains.

Those who disagree with Browne argue that finding the right drug combination is as much a part of rigorous treatment as anything else.

And that for some people, talk therapy can only start when they can emerge from a depressive fugue with the help of medication.

What both sides would agree on, however, is that drug treatment is only one part of how depression should be treated.

And the increasing number of drug prescriptions is also, as one British Medical Journal paper discovered in an analysis of UK statistics, due to patients remaining on medication long-term.

There are also anomalies worldwide in relation to prescription rates - a staggering 23pc of American women in their 40s and 50s are on antidepressants.

Though there are class divisions in the UK, there is a north-south divide in terms of antidepressant use. Ethnic minorities, even if they are poor, are less likely to be taking drugs for depression.

Closer to home, Limerick's high rate of prescription drug use could be linked to poverty rates, but Donegal, with the highest rate of social welfare, has a low rate of prescriptions for antidepressants.

The recession has also seen a surge in depression rates. Anyone who has worked with young people will have also noted the numbers among them presenting with anxiety and depression.

Ivor Browne attributes some of that alienation to the semi-detached world the young live in, highly connected by social media yet "in terms of personal relationships, hardly involved at all".

The other point he makes, which is specific to Ireland, is that "we have a very long traumatic history and a lot of those cultural attitudes from that, but on top we've applied this corporate culture.

"We've lost the personal to a frightening extent. It is a profoundly sick society, we can pretend all we like."

This loss of the personal is a theme that he returns to again and again.

"We are social creatures and we begin to die if we lose the personal, the sense of touch and love."

But if all of that sounds profoundly gloomy, he conversely has hopes of a sea-change, one that is coming from ordinary people rather than professionals, citing the numbers of people taking an interest in their physical wellbeing as well as alternative modes of relaxation.

"There's a virtual epidemic of mindfulness, it's people getting into the present and working on their own reality.

"I would see more hope with the lay public than with the professions, frankly."

Interestingly, he practises what he preaches. He undergoes a deep form of meditation regularly himself, in order to de-stress from the pressures of working with 'deep trauma' - "otherwise I would not be able to keep up this form of work", he says.

He also believes that spirituality begins where religion ends, and that it's the same message of love and being related to some divine power.afterlife

"The evidence is overwhelming for a life both before birth, and after death. A near-death experience tells you that consciousness is not just ascribed to the brain."

The rise of religious-based violence is evidence, he argues, of a polarising in the world, with some being motivated by hate and extremism, and on the other hand, there are people saying, "I don't want to be a part of this and looking for a more wholesome way to live".

Finding that wholesome way of living is a key message of his.

"You can't be healthy if you're living a fundamentally unhealthy lifestyle. It's not therapy as such, but even generally now in psychiatry, that emphasis is starting to come in, so that's a good sign."

Many of the patients he treats, he says, are on four or five different forms of medication, which they have to be weaned off of slowly

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