‘Every family has someone in mental health distress at the moment’
Psychiatrist Jim Lucey has written a prescription for the global pandemic. He hopes his new book will provide a much-needed boost for anyone who needs help now, he tells
Professor Jim Lucey and I begin our Zoom call with me asking how he is. “Well,” he says with a laugh, “it’s a long story really.” And we’re off, embarked on an interview that is chatty, discursive, anecdotal, full of reminiscences from Lucey’s 30-year career in medicine and psychiatry, all held together by discussion of his new book, A Whole New Plan For Living, written in response to the Covid crisis.
Lucey is Zooming from his garden shed, where he has been working since March, when the first lockdown coincided with his retirement as medical director of St Patrick’s University Hospital (although he continues seeing patients): “if you’re addicted to work, you just keep working. I have a 13-year-old — my five children go from age 31 to 13 — so this is a joy because the alternative is being in the kitchen with the homeschooling.”
Retirement was partly the result of planning, but partly too, of necessity. “In 2019 I developed a pneumonia as a result of a virus called RSV. It usually affects children but I was hospitalised and for a little while was quite sick. I got the fright of my life. They said it could be something to do with the fact that I have a congenital cleft palate. Anyway, it was part of my reason for stepping back from working so hard. I had planned this anyway but after the hospital stay, I was determined.”
Once Covid hit, he was advised to work exclusively from home. “For the first few months, I cocooned, living as far as possible in isolation at home. During those early months the frustration was enormous,” he admits, adding, “My family helped me through.”
At the same time, data began coming through about the impact Covid was having on our mental health, “20pc of the population with significant depression and anxiety and PTSD, and 40pc of frontline clinical staff”.
Lucey decided he wanted to find a way to help. The genesis for the book came from a conversation with his “older, smarter, and he would say better-looking brother”, a liver transplant physician living in America. “I was saying to him, ‘I’d like to recommend something that talks to the general public’, and he said, ‘look around. Can you recommend a book that is sensible and scientific and easily used and substantial?’ So I looked around. I read loads of books. I couldn’t find one. And he said, ‘you’ll have to write one yourself. But make it happy. Make it uplifting and positive.’ They were my ambitions — to be helpful and hopeful. Scientific and sensible; accessible and yet useful. And authentic.”
And so he wrote A Whole New Plan For Living, a book that he hopes “will help people to be happy”. Writing it, he says “was
We’re at our best when we are loving and being loved...
just as much a help to me”.
This is his third book, and very much aimed at “the vast bulk of people, rightly or wrongly, who will never see a psychiatrist; the general populace”. Even so, one in six of us, Lucey points out, will have a mental health disorder this year; prescriptions for antidepressants increased by 18pc between 2012 and 2017, and the dosage by 28pc; suicide is the most common cause of death for those under 50; and “at least one member of every family is in mental health distress at this very moment”.
Looked at like that, the landscape is alarming. But he also makes two key points. First, that none of this is inevitable, and second — crucially — the encouraging recovery rates. Depression, he points out, is more treatable than most cancers, recovery is always possible, even probable. Wellness, he says, exists before illness and it can be restored after it. The point he makes repeatedly — that mental health can be broken, and it can be fixed — is a bracing alternative to the enduring negative perception. There is, he agrees, still a lot of stigma around mental illness, even among professionals. “I get asked even by other doctors — ‘isn’t it very depressing being a psychiatrist? Isn’t it a pity you’re not in an area where you see any success?’ All my life I’ve been saying, ‘stop, I see more success than you do!’ Not that it’s a competition...”
The notion of authenticity is something that crops up repeatedly. The commandments he gives himself in his practice are: “Try and be authentic, try and tell the truth, try and listen” — all born out of a piece of advice given to him by Professor Anthony Clare at the beginning of his career — ‘you’ll never be any good unless you’re yourself’. It’s advice Lucey took to heart. “I present myself in work — not as a fragile spirit, he says, “but I take down my own barriers.”
It’s noticeable that the book cover gives his name, but not his title.
Helpful, hopeful, scientific, sensible,
accessible and useful… It’s a big ask. But I think he has achieved what he set out to do. A Whole New Plan is a book that starts small, with the fundamentals — sleep, exercise, diet — then, having gained the trust of readers with warm, practical, credible suggestions, moves out into deeper water. The “why” of life; the “how” of a contented life, all contained within what is almost a dialogue between author and reader. “I didn’t want to come across as certain in this book,” Lucey says. “When people come to me, I don’t tell them what to believe or what to do. That’s not what happens. We have a conversation and we unpack it and yes, we do start with trying to get sleep and exercise and self-care right, but ultimately we come to the point where we have to ask — ‘but who am I anyway?’ And then, ‘who can I love? How can I live?’.”
Sometimes, the suggestions can seem small; mere arrows against the artillery of mental distress, particularly at a time like this, but, as Lucey points out, “our lives are made of little small pieces. There’s something tremendous about accepting that. Going out and digging the garden is not a step that’s going to change the whole world, but it is actually good for us”. What we need, “are lots of small steps, to build them over a period of time”.
The heart of the book centres around the idea of humans as social animals, which is the crux of what’s called “social psychiatry”. “Social psychiatry believes that mental health recovery, mental health fulfilment, is that fulfilment which brings us into connection with others,” Lucey explains. “Which is about restoring our mind and body in a holistic sense, with the ability to live, work and love with others. Ultimately, we are fulfilled with each other, in each other. We’re at our best when we are loving and being loved.”
It’s a truth that is simultaneously small, and very large indeed.
“We have these myths,” he continues, “we have this idea that if we could get back to an agrarian, isolated man on a hill sucking sunflower seeds, we would somehow be happy. Nothing in a social psychiatrist’s point of view supports that. The whole progress of mankind has been moving from hunter-gather towards farm, town, city, collective. That progress is the triumph of our socialness.”
Having discussed the “why” and the “how”, he is deliberately not prescriptive about the “what”. “I didn’t want to say you must be part of a family, for example. No one can, or should, describe the shape of our lives. If your connections provide you with structure, with feedback, with support and reward, acknowledgment, regard, that’s what you want. And if that’s the Hell’s Angels, that’s OK.”
He talks about the book aiming “towards collaboration”, and cites as an example his own involvement with a musical group, and the benefits of this. “I very much believe that if you need to take a medical route, if you need to take medication — do that. But I also want you to join a band.”
So what instrument does he play? “I don’t play any instrument. I sing in the bath and I sing in a choir, but I’m very much not a lead singer. In the group, there are people with different musical talents — a fiddler, an oboeist — and they get me to read, or say stuff.” A bit like Bez in the Happy Mondays, I suggest? “Exactly!”
Prof Lucey came to psychiatry via a
slightly roundabout route. “I grew up in a general practice,” he says. “My mother was a GP, my father was a civil engineer.” Lucey was the fourth of five children, and initially anyway, didn’t know what he wanted to do. “I went to St Michael’s College in the 1970s; a very different world. I dropped out of several courses, including law. I wandered around, like many 19- or 20-yearolds, not knowing what to do. It was the year of punk, the year of rebels, and I was a bit of that. Then I went to the College of Surgeons as a late entrant.”
Psychiatry never occurred to him. “I had no intention of doing anything other than general practice; I was going to take over my mother’s practice.” That was until, as part of his training, he went to Temple Street “doing paediatrics”.
“I was in the oncology ward there, and I was deeply affected by the experience. I really was at the end of my tether. I got shingles, which is a stress-related thing. One day, I was sitting with a colleague, and he looked at me and he said, ‘you’re exhausted.’ And I was. He continued, ‘you know what you should do — six months’ psychiatry’.” And so he did, and “at the end of my time, I said ‘this is what I want to do’.”
He went to St Patrick’s, under Professor Anthony Clare, then to the UK, where he was consultant psychiatrist at St Bartholomew’s Hospital in London. Back in Ireland he worked at Connolly Hospital before eventually turning full circle and returning to St Patrick’s 20 years ago and becoming medical director.
What is it that appealed to him about psychiatry? “Time, the connection with people, the opportunity to work closely with them and the people around them.”
Along the way he got married and had his five children. “I never had to leave home — good or bad,” he says with a laugh. “I left home at 29 to get married. I had done loads of things, travelled all over Europe and Africa, but I was still living at home. That’s the way it was; a 29-year-old man who had dinner cooked every night.”
Besides the book, what’s next for him? “Hopefully, I’ll get to a place where I work in a way that’s normal, not 24/7. Balance,” he continues, “is a key idea of the book. I still have young children.” He talks about the 11-year gap between his older and younger children. “We call it the Big Family and the Little Family. The Big Family are grown up and doing their thing, and the Little Family are with us, and I hope to enjoy that more. I have this idea I’ll take lots of walks. I used to paint and I’d really like to get back to that again. I also used to dance a lot.”
What kind of dancing? “I’m a ‘70s kid, I was a disco jiver. I went on these French exchanges, I spent my time around Biarritz in the summers. They would take you to these parties — at first, they said ‘the Irishman can’t come because you can’t dance’, so I learned to dance. I remember asking this lovely French girl to dance and afterwards she said, ‘how do you know if the dance is good?’ I said I had no idea. She said, ‘if the girl likes it, the dance is good’. And that was an insight that became a lifelong discovery. It’s a social psychiatry observation: If the other person is engaged with your dance and likes it, it’s a good dance.”
As far as our conversation, and my reading of A Whole New Plan goes, it’s been a very good dance. ‘A Whole New Plan For Living’ by Jim Lucey is published by Hachette Books Ireland