A new book by well-known psychiatrist, Professor Patricia Casey, offers advice and guidance on psychiatric disorders and the various symptoms and therapies, while debunking some of the myths around mental illness. Here she is in person to explain more.

Tell us a bit about you, growing up in Ballynoe,  did you always want to study medicine?

Ballynoe was, and still is, a quiet little village in East Cork. I still go back to my family home every few weeks and I still have a great sense of being rooted to the place. It was lovely living in the country and also begins just 12 miles from the sea. I milked cows and saw calves and lambs being born. I went to wakes and funerals so I was aware of the natural processes of life from a young age. Consequently, I didn’t have much fear of them as I grew up. My mother was also very open (she was a public health nurse and had lived in England during the war for about 10 years). So my upbringing was one of openness. As a child I travelled with her in the car, during my holidays when she went to the dispensary and doing home visits. I loved doing that. It didn’t emerge as a desire to do medicine until I was studying for my Intermediate Certificate when we were studying biology and I had my eureka moment!  

What led you towards psychiatry and moving to Britain?

Simply because the post-graduate training schemes for psychiatry were far better developed in the UK. I knew I would get better clinical experience since psychiatry was better developed there than in Ireland.  I also knew I would have the opportunity to do research and possibly publish in journals and to me it was a “no brainer”. Once I started doing research, I got the bug for that also and it took me into academia, as well as continuing in clinical practice.

You have had a varied career in clinical practice and academia but what led to your work in the media?

This was not something I ever planned and the media was always something mysterious and remote from my life. My first contact with the media arose when I became Ireland’s first female Professor of Psychiatry and I was invited onto the Pat Kenny show. He invited me on a few times after that to discuss various issues and we talked about doing a series on mental illness. That did happen over the subsequent few months.  At the same time the X-case came before the Irish Courts and I expressed my opinion, which must have been a great surprise to many in the media. It was Baptism by Fire but I did a lot of media work in relation to that. Then just after that the terribly gruelling story of the death of 2-year-old Jamie Bolger case broke. I was terribly distressed by this and I approached the Irish Independent to write about it and so began my long association with The Independent. I also contributed occasional columns for other papers also So my media involvement came as a result of a confluence of hugely important events and political issues about which I felt strongly.

You've authored many books, what inspired you to write this book?

The Royal College of Psychiatrists in London, with which I have had a long and active involvement, published a book for the public about 10 years ago. I contributed a chapter to that, and it planted a seed. Over the years I have had the privilege of meeting hundreds of people up and down the country, giving public talks about various mental health topics. It struck me that a book by an Irish psychiatrist, for the Irish public was needed, if for nothing but to help them understand how to navigate to psychiatric services, which are almost impenetrable. Mental health receives a lot of publicity here also, so I thought a book that brings it all together in an accessible format for the general reader, was required.

Do you think that we have changed in our attitudes towards mental illness – in particular more serious mental health problems?

There has been a huge shift in attitudes to severe mental illness in this country among the general public. I think that because people in general don’t know what severe illness is and how it affects the life of those affected, there is a rather simplistic view of its causes and treatment. For example, people think that social conditions or having eccentric parents can cause schizophrenia. Regarding treatment the views are dangerously simplistic – drugs bad, talking therapies good! In fact, our asylums opened their doors, felled their high walls and were ultimately emptied because of the discovery of drugs to treat severe mental illness. Similarly talking therapies have increased the armamentarium for treating certain conditions for which drugs would be decidedly unsuitable. And just like pharmacological treatments, talking therapies too have side effects that are often not discussed, although there is now an increasing scientific literature discussing these.  

Do you believe that learning more about mental health conditions can help enlighten attitudes to mental illness and empower those with a mental illness?

Knowledge is a powerful tool in diminishing myths and in helping people’s awareness at every level. In reality, however, these fears and misunderstandings will never be totally eradicated. One need only look around us at the anti-vaxxers at present to appreciate this.

Might fellow professionals feel that some of these issues around the consultation process, diagnosis and disorders are not for 'non clinical' (lay) readers?

This never occurred to me. I decided to include something on the nature of the psychiatric consultation and on the process of diagnosis because these are questions that patients inquire about. They come to my office and often they don’t know what to expect. The knowledge of most people about psychiatry will come from One Flew Over the Cuckoo’s Nest or Analyse That. Regarding the process of diagnosis and the disorders themselves, I have never heard any colleagues say patients shouldn’t know about this. There is a wonderful chapter on the consultation process in one of my favourite books on psychiatry by Prof. Tom Burns from Oxford University called “Our necessary Shadow: The nature and Meaning of Psychiatry”. Having optimum information will assist those with possible or diagnosed mental illness, and their families, in so many ways, that I could write a chapter on that in itself. 

Tell us about the case vignettes, some are very powerful, do any of them stand out for you?

It should be realised that these vignettes highlighted in boxes in certain chapters are not exact stories about specific individuals but proxy examples of the typical cases we see. One is not allowed to publish real case histories from specific individuals without permission – this is true across the board in medicine so using general vignettes is the most ethical method.

For this reason, I sought the input of real patients, those who have mental health problems of various types and from their families. I asked them to write about whatever aspect of their condition they wished to focus on and of course I gave them the option of using their own name, a pseudonym or being anonymous.  I was thrilled with the response when I approached SHINE, an excellent mental health support organisation. Some of the contributors were also my own patients. I thought it was crucial to hear the voices of these people so that the readers could understand their courage and the resources they use as well as reading about the suffering that the families experience. It is often forgotten that the psychiatric services often let people down as some of the testimonies of the family members show. It’s not just enough to read a book by an “expert”: it becomes more pertinent if the voices of those directly affected are included. 

Many celebrities have been open about their mental health struggles – does it help normalise mental illness?

It is helpful up to a point, but there also comes a time when it may represent a degree of self-indulgence particularly when it is the same voice repeatedly.  I think that sometimes it’s best if people solve their problems in private. The public may also tire of it.

There is also a grave danger that understandable problems of living are medicalised when celebrities speak out and this is disempowering for people. Most people do not suffer from mental health problems. When they do, some are very serious and life destroying. The public doesn’t want to know about that. So, for example, when one points out that cannabis may cause psychosis and severe mental illness resulting in unemployment, homelessness and hospitalisation, the message is ignored.   

Why is there still a stigma about mental health? Headlines still tend to label violent perpetrators as "crazy" and there are still misconceptions about illness like schizophrenia?

Let’s face it, editors want a news story that will sell copies and words that have entered our lexicon from centuries of use are hard to extinguish. So terms like “split personality”,” crazed madman” are used to headline news reports and they reinforce our fears and misunderstandings. Guidelines to newspaper editors have improved things however so the use of inaccurate and judgemental language has decreased significantly.

Has your own opinion changed on how we can better promote mental wellness and our understanding of mental illness?

Yes. I used to think that publicity campaigns were the way to achieve this but now, from looking at such campaigns, I don’t think so. Individuals with mental illness who speak out on occasion are the best placed to remove stigma. We know from our research into stigma that knowing somebody with a mental illness is the best educator of all. My aspiration is that Fears, Phobias and Fantasies will help demystify mental illness and enhance our understanding of mental illness and what it is and is not.   

There has been much said and written about mental health issues during the pandemic, what's your own view on whether we will be able to cope with the ongoing mental health issues as a result of COVID-19?

It is likely that the mental health issues arising from Covid have been exaggerated. Most of the emotional reactions to Covid have been perfectly understandable and not indicative of mental illness. However, the impact of long-Covid on young people is beginning to be studied and this may place a burden on the services. In so far as Covid is mopping up resources, it’s an administrative one due to the absence of face-to-face consultations and difficulties obtaining appointments (particularly in child and adolescent psychiatry) that will put pressure on the services rather than any major increase in the prevalence of mental illness. 

Finally, where to next for you – is there a project or an ambition that is on the list for the future?

I am currently writing a Cochrane Systematic review. This is the highest level of psychiatric research as applied to clinical practice. These reviews bring together all the research in a particular topic and using complex statistical methods analyses the data as a whole. It is on the topic of pharmacological treatments in adults with adjustment disorder (the official name for a stressor triggered condition – see chapter 4 of my book!). I started with 4 other colleagues in 2013 and it was in abeyance for a few years, because of my own personal circumstances. I have resurrected it again with my colleagues. The standards set by the Cochrane Group are enormously high and it is intellectually very challenging. So, I’m hoping to get that finished later this year. I’m considering following with another after that.

Then there are a few other things in the pipeline academically, involving the Royal College in London and also in Notre Dame Medical School, Sydney where I am an adjunct professor. Clinical work is continuing. So, God willing, I’m staying around professionally.

Fears, Phobias & Fantasies by Prof. Patricia Casey, published by Currach Books, available now, €22.99, visit currachbooks.com.