I am a psychiatrist, a medical doctor who specializes in the treatment of mental illness. My new book, In Search of Madness: A Psychiatrist’s Travels Through the History of Mental Illness, looks at the story of psychiatry, the ways mental illness has been viewed throughout history, and how we can do better in the future.
For the book, I visited India, the US, Italy, Germany and a range of other countries, as well as many parts of Ireland. Everywhere I went, I dug into different aspects of the story of psychiatry and how we have treated people who are mentally ill.
Mental illness is common. Up to one person in four will be affected by a condition such as anxiety or depression over the course of their life, so this topic is relevant to everyone.
Most people with mental illness are successfully treated by their general practitioner or other local services, such as counselling. Lifestyle changes help with the emotional ups and downs of life and with certain psychological problems.
A minority of people with mental illness are referred to specialist mental health services. These people often have severe conditions or suicidal thoughts. They require specialist care in order to recover. In the book, I look at older models of care, including the large “mental hospitals” of the past, and compare them with modern approaches based on the idea of “care in the community”.
Most people who are referred to mental health services are treated as outpatients, in their homes and communities. In an ideal world, all community mental health teams would include psychiatrists, nurses, psychologists, social workers, occupational therapists and others. Ireland has some way to go to achieve this, but we are getting there. Some parts of the world have quite advanced services, but others lag behind. In certain countries, up to 75 per cent of people cannot access the care they need. This is shocking and indefensible.
A minority of people with severe mental illness require admission to inpatient psychiatric care, especially if the situation is urgent or if outpatient care has not helped enough. Ireland has a network of inpatient psychiatric units and dedicated hospitals covering the country. This resource needs to be improved, and progress is being made.
In my book, I explore these themes in different cultural settings and at different points in history. I start most chapters with a clinical case history to put a human story to the themes explored. I provide advice about common conditions such as depression, bipolar disorder (manic depression), schizophrenia and post-partum mental illness (including postnatal depression).
So, what are the take-home messages?
First, we need to distinguish between problems of living and serious mental disorders such as depression, bipolar disorder and schizophrenia. Psychiatric services are at their best when we focus on mental illness, rather than the emotional ups and downs of everyday life. It is harmful to medicalise unhappiness.
Second, neuroscience holds promise for the distant future, but current research needs to re-balance towards mental health services, anthropological explorations of illness and care, sociology, psychotherapy and trans-cultural examinations of suffering, healing, memory and meaning. The seductive allure of research technologies has blinded us to their limitations: all that glisters is not gold. We are not just brains; we have souls, too.
Third, we need to be more positive and realistic about psychiatric treatments. Used correctly, most medications work for most people most of the time, but they are not perfect and are not enough on their own. Psychological engagement and social support are vital. A balance is needed, delivered with humility, holism and hope.
Fourth, psychiatry is a social endeavour. We suffer, heal and help each other in families, communities and societies. We need community solutions for problems of living, accessible psychological care for mild issues, and specialist inpatient and outpatient psychiatric services for serious mental illness.
To make all of this happen, social and political activism is essential, to achieve better funding for psychiatric services, more housing for people with mental illness, a meaningful safety net for people who fall between the cracks, and reform of criminal law, court procedures and prison policies.
To effect change, use the political system. Register to vote. Join campaigns. Speak out. Get loud. People with mental illness and their families deserve no less. They have waited long enough. The time for justice is now.
(c) Brendan Kelly
About In Search of Madness:
A psychiatrist’s travels through the history of mental illness – Who is ‘mad’? Who is not? And who decides?
In this fascinating new exploration of mental illness, Professor Brendan Kelly examines ‘madness’ in history and how we have responded to it over the centuries.
We travel from the psychiatric institutions of India to Victorian scientific studies of the brain. Covering institutionalisation, lobotomy and the Nazis’ ‘Aktion T4’, as well as Freud, psychoanalysis, cognitive behavioural therapy (CBT) and neuroscience, Professor Kelly examines the shift from ‘psychobabble’ to ‘neurobabble’ in recent times.
In Search of Madness is an all-encompassing history of one of the most basic fears to haunt the human psyche, and it concludes with a passionate manifesto for change: four proposals to make mental health services more effective, accessible and just.
Order your copy online here.