Published in 2014, ‘In my Room’ is Consultant Psychiatrist Professor Jim Lucey’s first book. Subtitled ‘The Recovery Journey as Encountered By a Psychiatrist’ it is a collection of fifteen case histories that aims to give ‘an authentic description of the journey from distress to recovery’ as Professor Lucey has witnessed it throughout his more than 25 years experience in psychiatry. Case histories, each followed by a piece of poetry are grouped into chapters that are given names reflecting important aspects of human life and recovery such as ‘Freedom,’ ‘Memory’ and ‘Hope.’
Each case history does not represent a specific real life individual but is an amalgamation of patients treated by the author, intended to realistically convey the narrative of a person presenting in mental distress. While the book addresses diagnoses ranging from obsessive–compulsive disorder to bipolar affective disorder; it also explores concepts relevant to all diagnoses like stigma, insight and motivation. It deals with specifics – the side effects of Selective Serotonin Reuptake Inhibitors, the evidence for treatment duration following resolution of a depressive episode, the cognitive model of depression – but the book reads as if these more technical points are there to illustrate aspects of the case rather than solely to provide scientific information. The facts are presented clearly and would be understandable to those not from professional mental health backgrounds. The patient’s view of their illness, how it impacts on their relationships, family and work, and crucially how they recover is central in each vignette. In this way the picture of each individual is holistic.
‘In My Room’ informs the reader about the typical practice of the psychiatrist – getting to know the person and their symptoms and assessing whether or not this person has an illness according to diagnostic criteria. Then proceeding to treatment – recommending various biological, psychological and social remedies, all while developing a therapeutic rapport.
The patients in the book benefit from seeing the same psychiatrist at each visit and being in the same room, described as having ‘a high ceiling, a wooden desk, a bookcase and a number of comfortable soft chairs.’ This consistency is more reflective of the experience of seeing a psychiatrist in private practice and it reminds the reader of the importance of creating a ‘holding’ environment. The stability portrayed in the book may not be representative of public psychiatry but this book is entitled ‘In My Room’ – the author is not attempting to describe the mental healthcare system in Ireland as a whole. He is, however, whether he means to or not, drawing attention to a potential weakness in the structure of psychiatric care provision in public mental health services.
One of the challenges in writing a book about real life cases is how to preserve authenticity, while also getting a message across to the reader about the features of mental disorder. At times the patients’ descriptions of their difficulties did read more as a psychiatrist’s words or a section from a diagnostic manual. This was balanced, however, by the idiosyncratic turns of phrase used by the patients in the book which provide a very real and personal perspective on illness and recovery.
Psychiatrists are first doctors and this book reminds us why that is important. Whether it’s the patient dismayed at symptoms of undiagnosed Polycystic Ovarian Syndrome or Hashimoto’s Encephalopathy mimicking depression, the interplay between physical and mental health is frequently referenced. This message is increasingly relevant today as the ‘Medical Model’ of psychiatry is questioned and the role of the psychiatrist in mental health evolves.
When discussing the array of acute presentations to emergency departments in the Health Service Executive, the author speaks about the difference between mental distress – that is universal at some stage in life and can result in ‘acts of desperation’ such as self-poisoning – and mental disorder, a less common entity. This is an important distinction to understand for psychiatrists and lay people alike and his point is made in a fair and non-judgmental way.
Professor Lucey places a poem he admires after each case history and the collection includes famous pieces by Emily Dickinson and D.H. Lawrence. It provides a space for contemplation and allows the reader to become engaged on a more emotional level with the ideas put forward in the chapters.
Throughout the book the author banishes some myths about psychiatry and mental illness – that people never recover, that mental illness can be ‘contagious’ and overall the message is one of hope. But it also comes across in the book the work that goes into recovery – the long and challenging road to achieving insight into your own psyche. The point is made throughout the cases that mental illness is not something that can be cured by just visiting a psychiatrist and taking a medication – true recovery requires more than that. The process can be challenging – one of the patients in the book says ‘I will be all right just as soon as I am happy to get it all wrong,’ illustrating how recovery can require an about-turn in one’s thinking. For those not willing to make that change recovery is hampered. Anais Nin is quoted saying ‘The day came when the risk to remain tight in a bud was more painful than the risk it took to blossom.’
‘In My Room’ provides a broad perspective on mental illness and recovery. While there is a lot of talk about recovery and what it means, for Professor Lucey recovery ‘becomes apparent once we have learned to tame the anxiety of our unconscious mind and choose instead to adapt to life in a more connected and hopeful way.’ This book reveals helpful and real insights into how the journey to health is different for every individual and how as psychiatrists we can learn from each patient’s hard-won recovery.
Conflicts of Interest
None.
