If you have any fears of mental hospitals conjured up by movies such as One Flew Over The Cuckoo's Nest , they will be quickly allayed upon entering St Patrick's University Hospital in James Street, Dublin. The bright, modern interior has airy corridors, comfortable couches, an attractive glass-walled cafe and paintings hanging on warmly coloured walls.
There is nothing intimidating or remotely scary about the hospital which is Europe’s oldest mental health facility, founded in 1746 by Jonathan Swift, Dean of St Patrick’s Cathedral. Medical Director, Prof Jim Lucey – who is also clinical professor of psychiatry at Trinity College Dublin – comes across as a good-humoured, mild mannered man. The 55-year-old Dubliner , who sees people at their most vulnerable, has the reputation of being a kind, engaged, intelligent listener to his patients’ stories of mental distress.
“It’s about being authentic. You have to be genuinely with pain, anger, strife – to get above this yet not diminish it. It’s about listening to the truth about the experience of mental distress,” he says.
His new book In My Room – the Recovery Journey as Encountered by a Psychiatrist , is based on composite real-life experiences of depression, alcohol dependence, obsessive compulsive disorder and post-traumatic stress. What Lucey focuses on, though, is not treatment plans and therapeutic approaches, but how the individuals describe their experience and how, in most cases, they learn to move beyond it.
Each section of the book carries a theme – worth, freedom, memory, truth, balance, hope – and ends with a poem that encapsulates the transcendent qualities revealed. Lucey is a big fan of poetry.
"It's very relaxing and has high value in the concentration of words," he says. He also regularly uses personal stories of mental anguish to teach his medical students and to engage listeners in his slot on Today with Se án O'Rourke on RTÉ Radio 1.
“ I didn’t want to write a self-help book or a manual on depression so I asked my patients how to do it,” he explains.
Aware of the current interest in the genre (psychoanalyst Stephen Grosz's best- selling, The Examined Life was on his reading list), he set to work in December 2012 and finished the book a year later – grabbing time to write in the evenings and at weekends.
The book draws on real conversations with patients, such as the man who worked long hours to make up for financial losses following the Celtic Tiger years. A minor cycling crash sparked off depression and loss of concentration at work which he hid from his colleagues. It was later discovered that he suffered from hypothyroidism and an acute autoimmune disorder, known as Hashimoto’s encephalopathy. He was treated and made a full recovery.
Lucey firmly believes that the economic boom and bust have placed enormous demands on our mental health. “During the boom there were big demands on people’s productivity, there was less time for family life, and huge social, religious and political changes. A lot of people have been left with overwhelming debt. The problem was that the prospect of a healthy family life was never worked out. People were misled about the basic things in life.”
The recession brought a flood of people to his door. “We were struck by the large number of people coming to us overwhelmed with distress due to a combination of economic debt and stress in their lives. There has been a greater burden on people’s working lives, and on their family life. More burnout and more bullying and a big rise in workplace stress,” he says. “We found that every single person coming to us had contemplated suicide at some stage and then something happened to help them engage with us, whether it was surviving a suicide attempt or coming because a loved one brings them.
One of Lucey’s key motivations is to move society beyond the stigma and self-stigma of mental illness. “I’m naturally positive. We have come a long way in that people talk about and share their experiences of mental distress and that is a great achievement, but people still wait years to seek treatment.
“Panic, anxiety and other major distressed states are treatable and often by the time people get treatment, they have been suffering for 10 years or more. The earlier the interaction, the earlier people can move on.
“We also need to understand that mental distress is episodic and people need to be heard when they are ill, but not marginalised because of their distress. We still need to believe that people who suffer mental distress can live, work and love again. We don’t believe that yet [as a society] – particularly in Ireland because of the long shadow of asylums where 2 per cent of our population were kept.”
Lucey cites Dr Dorothy Keelan, former senior psychiatrist at the Mater Hospital and the late Prof Anthony Clare, former medical director of St Patrick’s Hospital, as the most significant influences on his decision to become a psychiatrist.
“Dr Keelan showed me how to engage with the whole life of the person in such an intelligent and kind way. And I was so fortunate to work with Dr Clare, who was generous in his teachings and insights and open about psychotherapy. He also saw art, poetry and literature all of value to working with mental health.”
The role of creative arts in mental health recovery, and the paintings throughout the modern, brightly lit, spacious hospital, are a testament to this changed approach to mental illness.
“I believe in recovery. I think pessimism is an error. There is a relentless negativity out there, but I believe the economic capital of our country is our mental health. When we are well, we will be prosperous and when we are prosperous, we must stay well.
“It’s unacceptable that 12.5 per cent of our population is unemployed and that one in four people will suffer a mental health problem. One third of patients attending their GPs have mental health distress. If we address these issues, we will recover and every family, school, sports club, fraternity has a stake in this. We need to look at our mental health in a much more positive way – by being sober, being in family – as well as engaging with recovery around mental distress.”
Personally, Lucey says he is sustained by family life. “I’m very well minded. They look after me,” he says. “With my wife, Philippine [to whom the book is dedicated], I have four daughters and a son to rear. I am in a choir. I love football and cinema. I go to the rugby matches. I do ordinary things – nothing remarkable .”
In fact, he is adamant not to be portrayed as either “a wounded healer or a super hero”. “I don’t want to be part of the cult of celebrity because that will distract patients from their journey to recovery. Every citizen in this country has a right to live a mentally healthy life.”
He clearly has no time for the faction- fighting between the medico-pharmacological approaches and the psychosocial approaches to treating mental illness. Lucey’s own research into obsessive compulsive disorder also helped him understand how intertwined physical and mental health is.
“Recovery is all about learning and we now know through brain imagery that psychotherapy changes the brain. Neurology, biology, pharmacology and psychology all play a part. It doesn’t help to be silent about these advances, but the patient is central in all of this learning,” he says.
Lucey also believes there will always be a need for in-patient facilities for people suffering from mental health problems.
“We all agree that it’s best to treat people close to home so that they can recover, to live, work and love independently. However, it is stigmatising to deny the need for intensive treatment for those who require it. Residential settings are necessary for some. To say that’s not the case is crazy.”
St Patrick’s Hospital has about 200 beds and treats many more through its Dean Clinics around the country and through on-line support and education.
Just before the interview ends, Lucey takes me outside to show me the old stone boundary wall at the back of the hospital. “I’d like to knock that down and build a new day service centre that people can walk into from the street.”
A willingness to find new ways to meet the mental health needs of the population is something of which he believes that the hospital’s founder, Jonathan Swift would approve .
In My Room – the Recovery Journey as Encountered by a Psychiatrist by Jim Lucey is published by Gill & Macmillan, €16.99
You can hear more audio from this series on
The author’s earnings from the book are given to St Patrick’s Mental Health Foundation for the Walk in My Shoes campaign to raise funds for young people with mental health problems
