e-Interview

Stephen Fry has an illustrious career in media and writing. He has been candid about his episodes of mental health problems. In 2009 he was awarded an honorary fellowship of the Royal College of Psychiatrists. He has written award-winning plays and books, and has had numerous television, stage and film appearances.

We are used to looking at mental illness, what does ‘mental wellness’ look like?

There is the great question. A balance of happiness and misery is our lot on earth, since pain and pleasure, dark and light seem to be built into the nature of our world. To judge what is ‘mental wellness’ is probably impossible. But it is something to do with being able to cope. Things will get bad, but somehow one copes (even after a lot of wailing and moaning and pain) - I think Archbishop Ramsay, decades ago, defined wisdom as the ability to cope, I would say that is what mental wellness is too.

The greatest pleasure in life is…?

Friendship, food, laughter - all together around one table.

Looking back on your life, what have you learnt and what would you do differently?

I would not have hidden my moments of distress and inability to cope so well. I hope I would not endlessly burden others with misery and angst (that is hardly the answer!) but just to have let people who loved me know when I was down and not able fully to manage.

What has been the highlight of your career?

Playing Oscar Wilde. Making a documentary series on bipolar disorder.

…and the lowlight?

The lowlight… well, running away from a West End play at the time was a lowlight, but the two above would never have happened without it, so perhaps it was a good thing.

Have you ever surprised yourself?

Every day.

Is the stigma regarding mental health issues changing?

Slowly it is, I really believe it is. There is a hell of a long way to go before the playground taunts and the adult equivalent are a thing of the past, but I do believe there is more understanding now than there has ever been and a greater awareness of the dangers of unattended mental health issues.

How do you think psychiatrists are perceived?

Among the so-called educated classes there is an unfortunate tendency to characterise psychiatrists as overcommitted to pharmaceutical interventions and too dismissive of talking therapy. It is a misapprehension and an unfortunate one. It tends to make paranoid assumptions about pill-pushing and being in the pay of Big Pharma. Amateur and semi-qualified therapists are perceived to be ‘more caring’ and although I do not dispute the genuine passion, commitment and kindness of many in the psychotherapeutic field, it saddens me that hard science and the areas of neurology, physiology and pharmacology can be dismissed by superstitious waves of the hand as ‘toxic’, ‘lazy’ or ‘arrogant’. Not all of this is the fault of the ignorant and unscientific; sometimes busy or impatient psychiatrists can contribute to this methodological schism. It is so harmful though, I believe, to the cause of mental health for the perception of this schism, even if - in truth - no sensible practitioner believes in it.

A disproportionately small percentage of medical students aspire to be psychiatrists and it is not completely clear why that is. How could more be encouraged to join?

It is a very good question. Perhaps the issue I mention at length above is partly to blame. Also, I think few realise the astounding satisfaction and fulfilment to be derived from helping and easing the pains of mental health. Doctors I have spoken to in some of the most deprived (and therefore affected by mental health issues) areas in the country simple love their work. It is perceived as being rooted in failure and characterised by the control of incurable problems by dangerous and obscuring medications. I think there is a much better story than that to tell and if students heard it they might be more drawn to the field.

What qualities should the ideal psychiatrist have?

Patience. Optimism. Cheerfulness. Kindness. Proper science.

The Royal College of Psychiatrists' strapline is ‘No health without mental health’. Do you have any suggestions for changing this?

I think it is good.

Is there any role for doctors in euthanasia?

Well, they provide the data on which decisions are taken. I think it is unfair of them to be made to mediate in the final decisions. They can give the facts of a patient under consideration, but they should not have to live with the decision-making process.

Where is psychiatry going?

Forward, fast, to new territories that will deliver astounding benefits - with the help of neurology, endocrinology and better epidemiological research of course.

Where might it go wrong?

Underfunding. Under-education. Understaffing.

Do you have any advice for us?

Be positive about the great strides psychiatry is making every year and about what a vital, optimistic and exciting field it is. The proper study of mankind is man and the proper study of man is the mind of man. As people understand more and more that we are all in different places on the continuum of mental health, the field will appeal more and more. At least that is my hope and, deep down, my belief…