Sir, - The Limerick psychiatrist Dr Peter Kirwan (December 28th) takes me to task for something I did not write. His comment - that "Dr Lynch would have us believe that unless a biochemical test is available to confirm the doctor's clinical diagnosis, no disorder exists, and no pharmacological treatment should be initiated" - suggests to me that he has misinterpreted my letter of December 20th. In attempting to paraphrase my letter, Dr Kirwan has in fact rewritten it.
I do not object to the use of medication per se when used appropriately and judiciously. However, I strongly object - and will continue to do so - when doctors make unsubstantiated and inaccurate statements about health issues, including medication.
The central thrust of my original letter was to challenge the highly suspect analogy - though an analogy frequently used by doctors - between diabetes and depression made by Dr Muiris Houston (Health, The Irish Times, December 17th). I note that Dr Kirwan does not refute my letter on that score.
By equating the treatment of depression with the treatment of physical pain - in particular his comments that pain relief should not be withheld from patients simply because there is no laboratory test for pain - Dr Kirwan is in effect acknowledging my point: that no biochemical tests exist to confirm any supposed biochemical abnormality in depression. Why, then, do many psychiatrists and GPs regularly inform their patients and the public that psychiatric medications re-balance biochemical brain abnormalities, when these supposed biochemical abnormalities remain unproven and untestable in their patients?
Dr Kirwan's equating of the use of medication for the relief of pain with the treatment of depression with medication is interesting, and far more accurate than Dr Muiris Houston's analogy between diabetes and depression.
I have long contended that psychiatric medication is to emotional distress what pain relief medication is to physical pain. Psychiatric medication numb feelings, anaesthetising the person's emotional pain and distress, providing what could be described as emotional pain relief.
I fully agree that reducing emotional distress with medication has its place, as does medication for physical pain. If psychiatric drugs are in effect emotional analgesics, then surely people have a right to be told this when they are being prescribed psychiatric medication, rather than the common though unproven medical explanation that the medication will correct biochemical brain abnormalities. The public is entitled to be accurately informed.
Regarding Dr Kirwan's analogy between the treatment of pain relief and the treatment of depression, in the treatment of pain, seeking to establish the underlying cause of the pain - what lies beneath the pain - is a central part of the doctor's role. Pain is not a clinical diagnosis in itself; it is a symptom requiring appropriate investigation and assessment.
Every final-year medical student knows that to administer ongoing pain relief without due consideration of causes and triggers is not good medical practice. Yet all too frequently in psychiatry and general practice doctors treat depression (and other psychiatric disorders) with medication without sufficiently exploring the underlying issues and without sufficiently seeking to understand, to listen to and to connect with the person sitting in front of them. - Yours, etc.,
Dr TERRY LYNCH,
Russell Court,
Ballykeefe,
Limerick.