Ivor Browne: The Writings of Ivor Browne.

By Ivor Browne
Atrium Press

Reviewed July 2013 – Sunday Business Post.

In 2008, Professor Ivor Browne published Music and Madness, a hugely popular book that was both a character-filled memoir and a critique, at the closing of a long career, of the current practice of psychiatry. Now follows The Writings of Ivor Browne, an eclectic collection of Browne’s articles and lectures dating from 1959 to the current decade. It is an intriguing, if sometimes infuriating, read.

The first thing this book does is to reaffirm that Ivor Browne is a crucial figure in the history of Irish psychiatry.

As Clinical Director of St Brendan’s Hospital in the 1960s, Browne, along with Dr Dermot Walsh, began the work of closing the asylums that dotted Ireland. It’s hard to overstate what a transformative change this was in the lives of people with mental illness. In his foreword to this book, Fintan O’Toole describes Browne as a “literal liberator… a key figure in the freeing of thousands of people from institutional incarceration”. Few would quibble with that assessment.

For this reader, the most enjoyable chapters in The Writings of Ivor Browne are those, like ‘Guided Evolution of a Community Mental Health Service: A Personal Odyssey’ that deal with the closure of the asylums, starting with Grangegorman.

Browne wrote ‘A Personal Odyssey’ in 1985, a decade from retirement. He wrote of his optimism in the 1960s as the great liberation began, and of his later dawning realisation that Ireland, particularly Dublin, in the 1970s and 1980s was a tough place to make your way if you had a serious mental illness.

Many who left the asylums thrived, but some struggled to survive in a fracturing society that was not ready to welcome them. What Browne is acknowledging here, I think, is that a liberation can have unintended consequences.

Browne continues to be an influential figure, whose views on mental health are much sought after by national newspapers. He has over many years moved to the margins of his chosen profession, but in publicly opposing much of mainstream psychiatry – which Fintan O’Toole’s foreword mischaracterises as “a model of psychiatry which relies only on the administration of drugs” – he has acquired the status, in the words of the Irish Independent, of a “fearless maverick with ideals”.

In this book, Browne offers a number of sharply worded assaults on physical treatments in psychiatry, such as electro-convulsive therapy (ECT). ECT has come under the spotlight in Ireland again in recent weeks, due to the decision by the government to amend the legislation governing ECT without consent.

Browne’s most pointed comments on ECT come in the article ‘Mental Illness – The Great Illusion’ and in a 2008 letter to the Irish Times. In each piece, Browne lists ECT, emotively but inaccurately, alongside historical “punitive procedures”, including purgings, bleedings, beatings, and frontal lobotomies. He also refers, in the midst of all this, to the mass murder of people with mental illness by the Nazis.

Are we to infer that 21^st century psychiatrists use ECT as punishment, or as an instrument of totalitarian oppression? If that’s an accepted view of mainstream psychiatry, we’re really in trouble.

Ivor Browne’s opposition to ECT is consistent with a central theme of his writings here, which is most clearly elucidated in ‘Suffering and the Growth of Love’, a lecture from 1997 that is reproduced here.

Browne argues that mental distress, such as depression, anxiety, or psychosis, is a sign that a person must change. Change can come only from within, through “work and suffering”, via psychotherapy, and any treatment that is externally imposed is either anathema (ECT) or inadequate (medication without psychotherapy).

There is a lot in this, and Browne’s point that mental suffering should not unthinkingly be medicated away is well made. But there are two problematic assumptions here.

The first is that orthodox psychiatry is purely biological, and ignores the social and psychological. In fact, community psychiatry today is defined by a holistic approach. I would be lost without the nurses, social workers, occupational therapists, and psychologists on my team. I would be worse than useless.

The second assumption is that mental suffering always means something. That’s an enticing idea, but it’s wrong.

We are social, psychological, and spiritual beings, but we are also clusters of cells, and sometimes those cells stop working as they should. Thyroid disease, a lesion in the temporal lobe, an autoimmune attack on a glutamate receptor, a dysfunction of the dopamine system: these can all result in distress that is real, and powerful, and even mystical — but it may not mean anything. It may be just chemistry.

Orthodox psychiatry can learn from Ivor Browne: we should push ourselves and our patients in a search for meaning when we can; when those are there to be found.

But Ivor Browne could learn from orthodox psychiatry too. Sometimes suffering is not a path to wisdom. Sometimes pain is pointless. Sometimes pain is just pain, and the job of the psychiatrist is no more complex or simple than this: to make it go away.