MEDICAL MATTERS/Dr Muiris Houston: The most recent Lundbeck Mental Health Barometer findings confirm that the stigma long associated with a range of mental health conditions is, unfortunately, still alive and well here.
Some 75 per cent of people surveyed believed there is either a lot or some social stigma attached to schizophrenia; 60 per cent said the same about depression; while 42 per cent felt there was significant stigma associated with anxiety disorder. But when the same people were asked about a range of medical illnesses such as heart disease, diabetes and arthritis, only a small percentage associated social stigma with these conditions.
Even though 300,000 people in the Republic have depression and 80 per cent of those surveyed believe it is a common condition, stigma levels remain high. What is it that prevents us from treating psychological problems like any other medical condition?
Is it just plain insensitivity? A radio advert for a Volkswagen car (the ad has since been withdrawn by the distributors here) featured a site engineer recounting his task of replacing an overflowing sewer in a flooded field at the back of a "prison for the criminally insane". A clear reference to the Central Mental Hospital (CMH) in Dundrum, it was withdrawn after families and health professionals objected to the images the advertisement conjured.
As Dr Paul O'Connell, consultant forensic psychiatrist at CMH, said: "the patients that I work with are those who by nature of having a severe mental illness fall foul of the law, perhaps by committing a violent offence in response to a delusion. All western societies recognise that when an offence of this kind occurs, as a product of mental illness, that hospital treatment rather than imprisonment is a civilised response."
In the same week, the State decided to proceed with plans to relocate CMH beside a new prison at Thornton Hall in north Dublin. The message from the decision is that patients in the hospital are part of the criminal rather than the health system. What could be more stigmatising for patients and their families than treating a healthcare facility as an appendage to a prison?
The Lundbeck survey found that 64 per cent of people would find depression a difficult subject to discuss with a doctor; some 62 per cent said they would be embarrassed to talk to a friend about the condition. Which leaves the burning question: Why?
It would require a different research format to explain the reason, but it would be most helpful to extend the survey in the future in an attempt to answer this central question. Could it be that stigma reflects denial? Given that almost every family has experienced mental illness in some form or other, often in a way that causes pain, is stigma a natural reaction to the denial triggered by mental illness? Or maybe it has something to do with the unpredictability of psychological illness compared with medical disease.
While most people have a concept of what is involved in medical illness, there can be a lack of clarity surrounding the progress and prognosis of mental health problems. Could it be that when an illness is more visible, it is less frightening?
Which reminds me of a conversation I had earlier this year with Prof Brian Leonard of the Brain and Behaviour Research Institute at the University of Maastricht and formerly of the pharmacology department at the National University of Ireland Galway. He is interested in whether depression causes physical illness, in particular heart disease, stroke and diabetes.
Prof Leonard cites evidence that overactivity of the adrenal glands found in depressed patients leads to high levels of cortisol in the blood. This, in turn, causes insulin resistance, a direct cause of type 2 diabetes. Insulin resistance increases the release of fatty acids into the blood, leading to high cholesterol levels. Cortisol also promotes the development of abdominal obesity. These fat changes increase the risk of blocked coronary arteries leading to heart attack.
People with depression are also known to have reduced immune function. They have higher rates of auto-immune disease such as rheumatoid arthritis, and patients successfully treated with antidepressants recover normal immune system functioning as the symptoms of depression lift.
As the evidence linking serious physical illness and depression mounts, it will be interesting to see if this helps to reduce the stigma. Ultimately better education and the demystification of psychological illness will be key to reducing this stigma.
Dr Muiris Houston is pleased to hear from readers, but regrets he cannot answer individual medical queries.