Madam,- Your Editorial of July 25th ("Time for quality in mental health") repeats many of the fallacies that bedevil the field.
In the first instance, the writer accepts uncritically that "mental health" is a medical issue, tacitly propagating the medical model of mental illness. According to the standard medical model, people are either healthy or ill; ill people require medical treatment, healthy people do not. This discrete classification does not apply to mental phenomena, where there is a continuous range of behaviours and it is simply not possible to draw a line on the distribution and say: "To the left are the sick people, to the right the healthy."
The very concept of medical illness is meaningless in the mental domain. There are just (an infinite number of) different ways of behaving. The only really useful criterion is whether the behaviour is socially acceptable or not. In other words, "mental illness" is a societal construct, not a medical one.
Secondly, your Editorial makes the extraordinary assertion that the health budget should be proportional to the number of "disabled". This is simply mistaken. You don't throw money at problems just because they're there. That is what leads to waste. You spend money where you can do good, where you have solutions, where you can bring benefit.
And that is the fundamental problem with the psychiatrist-led mental health sector. For the vast majority of its clients, the psychiatric profession has no solutions, no cures, no treatments, no procedures, no answers - none that work, anyway. One simply cannot compare the psychiatric profession with general medicine; to do so is to mislead oneself and to lend unwarranted credibility to the former.
There is no equivalent of the heart transplant in psychiatry, no antibiotics, no hip replacement, no coronary bypass. If you were to increase the psychiatry budget pro rata, what would you spend the money on? Double everyone's medication perhaps?
Where no solutions are available, where practitioners are fumbling in the dark with no idea of what they're doing, it would be sheer folly to award huge budget increases, except perhaps for research. Expenditure must be benefit-led, not problem-led.
As someone who has observed mental "illness" at close quarters for well over 30 years, it is my firm conviction that psychiatry does more harm than good. In such circumstances, it would be irresponsible to order more of the same.
Psychiatry is the great naked emperor of modern medicine and we desperately need to expose it as such.
Your Editorial regrets the fact that psychiatrists have refused to co-operate with the new mental health legislation. My advice to the Minister is: leave them out, we're better off without them. - Yours, etc,
Dr NORMAN STEWART,
Seapark,
Malahide,
Co Dublin.