I used to work in a relatively quiet pharmacy in a small suburb. There were prescriptions but there was also some time to enjoy the job and to talk to customers.
People with mental health problems have my sympathy and I try to offer moral support. As pharmacists we can talk to them about their medication, but I wonder how many of us do in reality. Earlier this year an article in Electronicjuice (8 May, p576) stated that pharmacists are not generally a source of information about antidepressants and that they play a limited role in depression. As for schizophrenia, these patients are forgotten people.
One can tell patients that there is a lag phase before antidepressants establish their effect and not to join the French Foreign Legion before this therapeutic response; to watch for side effects like dry mouth and constipation and if these are troubling them discuss a change of drug with their prescriber. Also, as we know from studies, we can tell them that courses of antidepressants should continue for at least six to nine months.
What really interests me, though, is a couple of non-pharmacological approaches. The first is a novel idea called bibliotherapy, started in a library in Huddersfield. The idea is to encourage patients with depression to read novels, and this seems like a good thing to me.
The second is something that has been part and parcel of my life for over 20 years. It is a type of meditation called Sahaja yoga. Sahaja yoga is a pluralistic faith and its founder was Shri Mataji Nirmala Devi. She was awarded the United Nations Peace Medal in 1989.
When I worked in the pharmacy I used to pass written details of this yoga, which is without charge, to patients if they were interested. It helped that regular weekly meetings took place in a town nearby and the fruit and vegetable shop next to the pharmacy displayed a poster. The details included a brief outline of some of the vocabulary used — kundalini, meaning the Holy Spirit, chakras, and brahmandhra, meaning hole to God at the top of the head. They also mentioned a website, , and an Ayatollah’s letter of recommendation. I believe that is quite a courageous letter if you consider that his reputation might be impugned by more orthodox views. In Russia there has been medical research into Sahaja yoga — medicine for a new age indeed.
Something that ties in neatly with both reading and Sahaja yoga is a quotation from James Joyce: “God spoke to you by so many voices but you would not hear.” Religions speak through many different voices and languages and in Sahaja yoga there is a wonderful harmony and incorporation of different faiths.
James Joyce is a useful lead-in to patients with schizophrenia, especially as Schizophrenia Ireland names its awareness day Lucia Day, after Joyce’s daughter, a long-term sufferer. Some critics think that Lucia’s mental state differed only in degree rather than essence from that of James Joyce. Carl Jung, the psychologist, famously remarked on Joyce’s ability to cope with the same problems as his daughter, and Harriet Shaw Weaver, one of Joyce’s supporters, said there was something medicinal for the soul about his work. Cascades of light do indeed come from ‘Ulysses’ and scholarly research continues into his work, including the mysterious ‘Finnegans wake’. Joyce died before explaining this last work fully and we must look to the scholars for more insight. The website is a good resource for those interested in Joyce.
I hope I added value to my patients’ prescriptions.