The author of a new book has produced a unique system explaining the biology behind mental illness A GP explains mood disturbances in a fresh and accessible way. Dr Muiris Houston, Medical Correspondent, reports
Have you ever come across a book that fundamentally changed your understanding of a subject? One that triggered a significant tipping point in your concept of a topic?
Flagging the Problem: a new approach to mental health (Liberties Press) is such a rarity. Published today, the book by Dr Harry Barry will alter and deepen your understanding of how the mind works.
In particular, it has the capacity to help the 400,000 people in the Republic with depression understand their illness better and it offers a candle of hope to the 450 families whose lives are blighted by suicide each year.
Barry, a GP in Drogheda for 26 years, has a particular interest in the problems of depression, addiction, anxiety and suicide.
He says his motivation in writing the book was the strong feeling that depression is badly understood, coupled with a desire to explain why mental illness happens.
The suicide in 2002 of Niall, the son of one of his patients, was the trigger that galvanised the four years of research and writing to complete the book.
In the past five years, in particular, there has been an explosion of scientific research into mental illness.
What Barry has done is to combine these latest findings with his 30 years of clinical experience, to produce a unique system explaining the biology behind mental illness.
"During my research I realised that the first letters of the main components of the biological mood system [ the Frontal and Limbic mood departments in the brain, the Adrenal gland and the stress hormone Glucocortisol] make up the word FLAG."
And so the book is made up of five main sections. Each one is marked with a coloured flag which represents a particular mental state or illness: green flag explains the normal mood system, red flag deals with depression, yellow flag for anxiety and a purple flag for addiction. A white flag, the symbol of surrender, deals with suicide.
The system is very effective: it enables the reader to visualise the illnesses, their symptoms and biology as well as understand how and where various treatments work.
Barry has coined the term "mood system" to simplify what is a highly complex biological network within the body. In the brain there are two mood departments: the frontal department at the front of the brain which regulates behaviour (the behaviour box) and the limbic department, located in the centre of the brain, which contains a memory box, a stress box and a pleasure box.
The two mood departments are in constant communication by means of three long connections, called mood cables. Each one is named after the predominant chemical messenger it uses: serotonin, dopamine and noradrenaline. The mood system is completed by the adrenal glands which are situated on top of the kidneys.
The stress box sends messages to these glands, prompting the production of adrenaline, noradrenaline and glucocortisol. The first two hormones prepare the body to face a sudden threat, while glucocortisol fights stress, illness and infection. But when we suffer stress and depression, cortisol levels remain elevated and, as a result, the hormone fights the brain itself, resulting in damage to the memory box.
Because each element of the FLAG is closely interwoven, interference or damage to any one section causes the mood system to break down, eventually leading to psychological illness. But does such a visualisation of the mind not risk dehumanising or devaluing the human person?
What about our unique individuality? Barry acknowledges this concern and says "it is important not to see the body or the mind as being somehow distinct from the brain . . . the mind [ both emotional and logical] is a function of the brain . . . so by definition, mental illness, and any approach to dealing with it, must involve the brain itself".
"Depression has been clouded by a myth for a long time. It is often believed that it is a weakness, a personal flaw in the sufferer. It is time to break this myth," Barry writes. The chapter on the Red Flag of Depression (see panel) achieves this goal admirably.
He describes what happens within the mood system during depression: first the behaviour box in the frontal department malfunctions, leading to an increase in negative thinking. New imaging techniques show overactivity in a key part of the brain leading to poor concentration and anxiety.
The adrenal glands go into overdrive leading to damage to the memory box in the brain and extreme fatigue. From a holistic perspective, it is interesting to learn that excessive levels of the glucocortisol hormone causes a 200-500 per cent increase in the risk of heart disease, as well as poor bone formation (osteoporosis), emphasising the close link between psychological and physical illness.
Barry says the cause of depression is primarily genetic, with outside environmental stressors influencing the timing of the illness. "But poor diet, misuse of alcohol and drugs, and a lack of exercise all play an important auxillary role."
He advocates a multifaceted approach to treatment, combining diet, exercise, drug treatment and counselling. He explains in detail how each treatment type brings about specific changes in the FLAG system, which patients and their families will find is a persuasive argument for a holistic approach to the treatment of depression.
What about the old chestnut of a psychological versus a pharmaceutical approach to depression?
Barry is in favour of both. He explains that cognitive behavioural therapy (CBT) helps the person use their frontal behavioural box to overrule the negative thoughts coming from the stress box in the limbic department.
Anti-depressants reduce activity in the stress box and increase activity in the memory box as well as stimulating the mood cables. In essence, drug therapy works from the bottom of the brain upwards while CBT operates from the top downwards, suggesting that a combination of both may be the ideal way of treating the illness.
According to Barry, depression is the biggest trigger for suicide. His explanation of the biology of suicide is excellent and could help those who have lost a loved one achieve a greater understanding of why it happened.
While depression and alcohol seem to be triggers for suicide in all age groups, he describes additional factors that seem to play a part in the under-25s and in older people. And he writes at length about the prevention of suicide.
Flagging the Problem is a superb book. It explains mood disturbances in a fresh and accessible way. I cannot recommend it highly enough, in particular to those travelling the lonely journey of mental illness, and their families.