Madam, - Breda O'Brien (Nov 11th) would like depression to be understood as a medical condition, just like heart disease and diabetes. She even calls Tim O'Malley, the Minister of State with responsibility for mental health, "downright irresponsible" for saying that "there's a very strong view with a lot of people that depression. . . is not a mental illness". In the same article she also calls for a debate on mental illness.
I have no doubt Ms O'Brien can readily find research which proves that medication is beneficial, since the drug companies fund this kind of research all the time. However where is the proof that depression or any "mental illness" has a physical cause? When psychiatry can produce physical evidence that depression has a medical cause, then it can be scientifically concluded that mental illness is indeed a medical condition. Until then, the view of "a lot of people" that depression has to do with emotions and life events should be respected by journalists like Ms O'Brien. - Yours, etc,
PAUL MAHER, Knockroe, Anacarty, Co Tipperary.
Madam, - Breda O'Brien calls Minister of State Tim O'Malley "irresponsible" for questioning the efficacy of drugs marketed as anti-depressants (Opinion, Nov 11th).
In reality, the Minister is only echoing a growing concern in the medical profession that these drugs have been overused.
Ms O'Brien maintains that these drugs and others have "revolutionised" the management of mental illness. As practising psychiatrists, we would beg to differ. We prescribe psychiatric drugs and some patients benefit but the fact is that many do not. And there is also an ongoing debate about how these drugs have their effects.
Some prominent medical commentators have pointed to a very large placebo effect in studies of anti-depressants. In addition, it is now clear that studies carried out by researchers who have ties to the pharmaceutical industry are much more likely to show a benefit compared to more independent research.
There are increasing concerns that the serious side-effects of these drugs have been systematically played down. These debates take place in a context where "market expansion" is top of the agenda for the pharmaceutical industry.
In our opinion, the Minister is quite correct when he highlights the fact that the field of mental health is one of debate and discussion.
He is simply acknowledging the reality and the importance of this debate.
He is also right in his assertion that there are valid alternatives to the biomedical framing of states of sadness, distress and alienation. Mental illness can be life threatening.
Many service users report difficulties engaging with services that are dogmatic and narrowly biomedical.
In this context, if any views can be labelled "dangerous" it is the sort of dogmatic dismissal of these alternatives put forward by Ms O'Brien.
Genuine science is always a matter of questioning and doubt and not of certainty and dogma. - Yours, etc,
Dr PAT BRACKEN; Prof MARCELLINO SMYTH, West Cork Mental Service, Bantry General Hospital, Bantry, Co Cork.