Before the advances of modern medicine, how did our ancestors deal with mental illness? Charles Caleb Colton (1777–1832) believed that there were three ways to bear the ills of life: by indifference, by philosophy and by religion.1
Philosophy played a large role in assisting those of our ancestors who were literate in managing mental illness, and we are fortunate that much that was written by philosophers in those early days is still available to us today, but do we pay enough respect to their teachings? Do we tend to provide a ‘quick fix’ prescription rather than guiding our patients through the many other things that they can do other than take medication? One in six Australians (4.8 million people) were prescribed a mental health medication in 2022, and 73% of these prescriptions were for antidepressant medication.2
There is plenty of evidence showing that modern antidepressants and anxiolytics are beneficial, but these medications have variable efficacy and a multitude of side effects.3 The product information for sertraline lists over 40 side effects, and over 80 more were added in the post-marketing period (Zoloft product information; New York City, NY, USA: Pfizer, 1991).
Do we ensure that we are doing the best thing for a patient by prescribing medications that will be efficacious and free of side effects and by always checking that they are necessary?
A pharmacogenomic screen may assist in guiding medication use, but in the author’s experience, such tests are not commonly used in practice, and they are also not funded by Medicare. There may be a case for performing such a screen on any patient who is to be prescribed long-term medications, particularly if there has been a failed response to treatment.4
Anxiety, depression and post-traumatic stress disorder all benefit from non-medication approaches (Tables 1 and 2), and these illnesses are often intertwined with related disorders, such as insomnia, stress and chronic pain. All these conditions are intensely personal, and because of this, their management rests largely on what the individual does to manage them.5–10
The concept of brain dialysis
Brain dialysis consists of all the things that we must do to stay free of mental illness.11 It is not only useful for prevention, but also for treatment. Self-belief, self-discipline, learning from mistakes, anger management, aspiration, change management, meditation, mindfulness, relationship management and a healthy lifestyle all form part of brain dialysis and were all topics covered by the philosophers.
Conclusion
A philosophical approach to managing mental illness is not a substitute for medication, but it is a tool that augments the overall management of a patient with a mental health illness and contributes to a holistic approach to their care. Finding the correct balance between the use of medication and the use of non-medication methods is an art, and as general practitioners, we should be coaches who guide our patients through the many options that are available for their individual circumstances.
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Table 1. The non-medication management of depression
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Key points in managing depression11
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Philosophers’ advice for depression
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• You must fight depression head on to beat it. Be active, not passive. (Philosophy)
• Mindfulness, behavioural change and meditation are effective. (Psychology)
• Keep a healthy lifestyle: exercise every day, pay attention to sleep hygiene, avoid excessive use of caffeine, alcohol and all recreational drugs. (Lifestyle)
• Use green and blue spaces for exercise, hobbies and relaxation. (Lifestyle)
• Make yourself do something that you enjoy every day. (Philosophy)
• Keep a routine to make sure you do what you must do each day. (Philosophy)
• Keep your priorities in the order that they should be in; put yourself first in anything you do in life but in a selfless way, not a selfish way. (Philosophy)
• Never look backwards. Do not let negative thoughts and thinking take over. (Philosophy)
• Learn from your mistakes, they are a positive thing; you learn much more from losing than you do from winning. (Philosophy)
• Do not be hard on yourself when things get tough; that is when you are most likely to make a mistake, but also when you will learn the most. (Philosophy)
• Pain can be your best teacher – mental pain much more than physical pain. (Philosophy)
• Maintain a vision for your future and be ambitious; hope, ambition, aspiration and purpose all fly in the face of depression. (Philosophy)
• The management of depression is multifaceted; try different things.
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• Everything is hard before it is easy.
Goethe (1749–1832)
• The longer we dwell on our misfortunes, the greater is their power to harm us.
Voltaire (1694–1778)
• If you are in a bad mood, go for a walk. If you are still in a bad mood, go for another walk.
Hippocrates (460–370 bc)
• Through self-discipline comes freedom.
Aristotle (384–322 bc)
• A wise man should consider that health is the greatest of all human blessings, and learn how, by his own thought, to derive benefit from his illnesses.
Hippocrates (460–370 bc)
• Anybody can become angry – that is easy. But to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy.
Aristotle (384–322 bc)
• It is during our darkest moments that we must focus to see the light.
Aristotle (384–322 bc)
• Suffering becomes beautiful when anyone bears great calamities with cheerfulness, not through insensibility but through greatness of mind.
Aristotle (384–322 bc)
• Great is the power of habit. It teaches us to bear fatigue and to despise wounds and pain.
Cicero (106–43 bc)
• He who has a why to live can bear with almost any how.
Nietzsche (1844–1900)
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Table 2. The non-medication management of stress and anxiety
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Key points in managing stress and anxiety11
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Philosophers’ advice for anxiety
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• Manage the things you can manage and try to ignore the things you cannot. (Philosophy)
• Anxiety is normal, but it needs to be controlled to keep it working for you and not against you. (Psychology)
• Reduce screen time. (Lifestyle)
• Keep a balance in life and do not bring work home, both in a mental sense as well as in a physical sense. (Lifestyle)
• Work on managing insomnia. (Lifestyle)
• Avoid excessive use of alcohol, caffeine and all recreational drugs. (Lifestyle)
• Keep your thinking brain in charge and practise methods to stop your subconscious brain taking over, such as meditation, mindfulness, breathing and relaxation techniques. (Psychology)
• Avoid non-helpful behaviours and thinking. (Psychology)
• The management of anxiety is multifaceted; try different things.
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• Nothing in the affairs of men is worthy of great anxiety.
Plato (428–348 bc)
• There is only one way to happiness, and that is to cease worrying about things which are beyond the power of our will. We have no power over external things, and the good that ought to be the object of our earnest pursuit is to be found only within ourselves.
Epictetus (50–135)
• The greatest weapon against stress is our ability to choose one thought over another.
William James (1842–1910)
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