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With suicide one of the foremost killers in Ireland, there are alternatives to conventional medicine in treating mental health problems.
Colm Kelpie reports from Galway.

Suicide is one of the principal killers in Ireland today. In the first 6 months of last year, 191 people ended their own lives in this country. The total figure for 2003, was 444. Figures released from the Central Statistics Office show the death rate from suicide in Ireland has doubled since 1976. Why?

There is no simple answer. People resort to taking their own lives for different, complex and personal reasons and there can, at times, be no obvious excuse or explanation why someone would be moved to such extremes. Studies on this issue have shown that social factors can be highly important in determining the causes of suicide. A recent survey conducted by the Samaritans in 2003 revealed that anxiety, increasing pressures of modern life and low self-esteem would appear to be among the major causes.

Psychiatric disorders, usually depression, are present in 90 percent of people who take their own lives, according to statistics from the Irish based support group, AWARE. Depression is a highly common illness in modern Ireland, yet we know worryingly little about it.

For many, the idea of therapy means a GP, medical records, psychiatrists and, in a lot of cases, pills. Many people suffering depression are unsure of who to turn to for help, or if they should even seek help. To speak with a medical professional involves the attached stigma and fear of being branded as having a mental problem.

This, possibly, is where psychotherapy comes in. Completely confidential and, unlike psychiatry, involving no medical records, psychotherapy is a talking based remedy for mental health problems. Non-medication based, psychotherapy emphasises the need to talk and explore issues.

“Psychotherapy is primarily therapy for the mind or the spirit”, says Marych O’ Sullivan (52), a registered Psychoanalytic Psychotherapist. “I deal with the ‘walking-well’ primarily, not necessarily mentally ill people, but just ordinary people who may run into crisis or have some sort of pain internally.”

Psychoanalytic psychotherapy is based upon the idea that much of our behaviour, thoughts and attitudes are regulated by the unconscious portion of our mind and are not within ordinary conscious control. By inviting patients to talk, Marych explained, the psychoanalytic therapist helps people to reveal unconscious needs, motivations, wishes and memories in order to gain conscious control of their lives.

Marych treats a wide variety of patients in her small office in Woodquay, Galway, ranging from teenagers suffering adolescent emotional problems, to people suffering from terminal illnesses. Soothing music comes from a CD player in her office foyer, and explanatory leaflets detailing the benefits of psychotherapy, and her own qualifications in treating patients, rest on a small table.

“If your leg starts paining and it continues to pain, it will get your attention and you’ll bring it to a doctor. So, if somebody has emotional pain, meaning they’re feeling stuck or just feeling inadequate or lacking in confidence, they’ll come to a psychotherapist”, she says.

Marych is not a medical doctor, but has extensive training in the field of mental health having been awarded a Masters Degree from the Department of Mental Health in Trinity College, Dublin. She has been practicing psychotherapy since 1990.

“The one difference between psychiatrists and psychotherapists is that psychiatrists can prescribe medication”, Marych says, when asked if there is a difference between psychotherapy and other counselling professions like psychiatry.

“If you’re looking at me from the position of a very ‘old-school’ psychiatrist, you’ll say I’m off the wall”, says Marych, noting a lot of psychiatrists only think you can deal with a problem through medication.

“But many psychiatrists see that there is room for psychotherapy, as well as the medical training and understanding that a psychiatrist will have”, stresses Marych.

Essentially, psychiatrists will have the skills and qualifications necessary to diagnose severe mental illness, but psychotherapists primarily deal with “emotional crisis or pain that needs support”, support that doesn’t necessarily require the intervention of drugs.

“Somebody might go to their doctor feeling depressed. The doctor might feel they don’t necessarily require drugs, but there may be something they need to talk about, in which case they send them to me. So, it would be a talking cure”, says Marych.

Prescribing medication to treat depression and mental problems has a ‘hit and miss’ success rate. One consultant psychiatrist with University College Hospital in Cork, believes that 30 percent of people treated for depression cannot be ‘cured’ by antidepressants, yet, explained the majority of depression sufferers will be prescribed various forms of anti-depressants.

However, Marych is at pains to point out that while psychotherapy is a non-medication based treatment, she and other members of her profession believe that conventional medical treatment is required on many occasions. Asked if she would encourage people on medication who come to her for treatment to go off their pills, she emphatically says no.

“I get a lot of patient referrals from GP’s, many of whom have been prescribed medication, and I will get people directed to me without medication”, she says. “I have also referred people to go to their GP or their psychiatrist if I feel that person needs medication support.”

However, she points out that talking about a problem and trying to resolve it without the intervention of drugs, can, at times, be just as effective.

“I do believe in medication, but I think it can be over-prescribed and GP’s can be trigger-happy with anti-depressants”, she says. “Prescribing is a skill, as is diagnosing. Some doctors are wonderful at diagnosing.”

Estimating the success of psychotherapy in comparison with conventional medication is difficult, ,as each person will respond differently to treatment.

“There are some people who are too fragile to become conscious of anything, and if they did, they would crack.”, says Marych, but, “I don’t think it makes sense if a person does not get space to talk about issues. You have a certain amount of people, who come in here, go at it, deeper and deeper, and come out the other side. I would find only medication [in treating depression] very difficult to understand.”