Mental health policy: Be careful what you wish for.

It’s difficult not to stand behind a rallying call to alleviate distress; especially if you suffer from it yourself. Politicians like Nick Clegg are making it their banner at the next election. It’s said their politically strategy for 2015 is to appeal to the green middle classes. The focus on mental health fulfils one of their goals, appealing to middle class parents concerned their children are on the verge of mental breakdown and need more support, especially of a financial nature. Politicians however, are being too eager to pour money into a structure where success hasn’t been proven. Politicians, however, are unable to step back and tolerate uncertainty while we search for a solution. As laudable as a focus on mental health is, without pause we risk making a fragile situation even worse.

The first problem is swallowing the statistics from the disorder industry without question. Clegg himself in January parroted the one in ten young people suffer from a mental disorder statistic. Do one in ten really have a critical disorder? No. Delve into the statistics a little bit more and you find half of the children in this category suffer from something called a ‘behavioural disorder’. Take one of these disorder “Oppositional defiant disorder” (Or what I prefer to brand “Obnoxious dickhead disease”) classified as the “Frequent refusal to obey parents or other authority figures” otherwise known as being an eleven year old. Disorders such as these came under criticism from prominent psychologists such as Peter Kinderman of the University of Liverpool. This isn’t to deny a child’s behaviour can be problematic, but with a blanket expansion of CAMHS we run the risk of psychiatrists being able to run amok and expand the burden of mental ‘disease’ further. Academics are starting to rebel at the over diagnosis of dyslexia.  Putting aside debate over the existence of the disorder, the evidence shows the label is doing nothing to help those afflicted with it. There aren’t any implications for treatment, and the best it does is allow middle class elbow to secure more funding and  assistance for their child. I was banded by CAMHS when I was younger, giving my school more financial assistance for my uh, behaviours, but when seen by a psychiatrist he shunned from giving me a label and decided I would grow into myself. Here I am now. Replace this with the current climate where there will be desperation for parents and children alike to cling to a diagnosis and we will pathologies the entirety of childhood.

Desperate middle class parents run in tandem with the interests of the psychiatry profession. As revealed in James Davies book Cracked the current head of the Royal College of Psychiatrists doesn’t appear to be interested in debating the evidence and track record of its own house and is entirely obsessed with getting the ‘disease’ status. Something being a disease is attached to money, money allows you to expand the profession, expanding the profession gives you the resources to lobby more saps like Clegg.  Norman Lamb falls prey to this too, quoting research from Time To Change indicating mental health stigma is going down. What is actually happening is the perception from a personal failing is turning into the perception people are falling prey to a disease to be medicalised. Progress? Perhaps not when we see people are treated with even less empathy when being seen this way

Worldwide the focus is more vague. The current head of the World Psychiatric Association thinks the focus should be on turning psychiatrists into social workers. Rather than seeking out ‘ social inequalities’ and trying to manufacture better public relations with gay people and women you would think his focus should be on the dire record of psychiatry full stop. Medications which don’t work, not to mention their side effects. The relationship between his profession and corporate institutions. Even things as simple as improving the DSM are seen as irrelevant. I’m not hostile to the concept of psychiatry; I know from personal experience mental anguish is real and rehabilitating, but we have an establishment abandoning what should be the aims of their practice in favour of their institutional interest.

Psychologists aren’t innocent either. They primarily have the ear of the government at the moment, hence the massive expansion of assess to clinical therapies such as Cognitive Behavioural Therapy (CBT) under the last government and the current. Academic advisors such as Richard Layard spearheaded it into the NHS and continue to bang the drum as it being a catchall saviour to our woes in books such as Thrive, devoured by right thinking people. CBT isn’t and cannot be this solution, despite it being useful in many circumstances. When the British Psychological Society are criticised over their weakly evidenced report in favour of CBT it too lashes out and calls for unity. One of the authors said criticism must be reserved for journals rather than the internet. Kinderman, referenced earlier, goes down into the comments to condemn the authors for not putting on a united front.

Any taskforce instituted by a government must down the route of insisting we discover what works before we devote resources to expanding the institutional power of the professions where we can’t even have confidence their remedies relieve our ailments. Mental health research is too neglected and too underfunded. The new charity Mental MQ is developing a project to discover what courses of action people respond to; congratulations to them for reminding us what clinical practice should be about. By the time any of this research comes to light, we may live in a world of the insane led by those who are insane enough to think they can cure insanity.

On suicide and selfishness. The mentally ill are people too.

An outpour of sympathy and new awareness spilled in the wake of the death of Robin Williams. Equally there has been an outcry of condemnation against anyone who questioned the reasons as to why he would want to take his own life. Calling someone selfish is an act of stigmatisation and cruelty.  Some motivated by spite as in the case of Fox News, some misgivings out of ignorance like our own health secretary Jeremy Hunt, and finally out of a sense of Christian morality.

The backlash against these people is understandable because people want to see themselves as being on the side of the downtrodden victim. However, to brand mentally ill people as victims  entirely misunderstands the nature of most people with these conditions. It’s perfectly possible to brand the act of suicide as selfish without branding it the absolute indicator of someone’s moral character.

I don’t want to comment on the path Robin Williams took before his decision.  People much more qualified than me can cover the background to personal debt and Parkinson’s. I didn’t know him, so I can’t comment on whether he was a good person. Suicide, whatever the background, is still selfish. It leaves victims around you; the oft quoted statistic is each suicide leaves behind on average six to ten survivors. Suicide imposes a torture on them equal to battles with depression.

Anxiety, hopelessness, guilt,  everything someone who tries to escape through killing themselves transfers onto other people.  It never reduces a burden, it is never a selfless act. You may respond to this by saying depressed people suffer from a disease and therefore have no control over their actions. This is nonsense.

Depression and other mental disorders cause mental suffering. They don’t turn you into a mental and a moral cripple.

Not only is the notion is depressed people have no autonomy dehumanising, but it’s also exceptionally dangerous. Suicide is rarely something done spontaneously: it’s a process. Presenting suicide attempts as the inevitable outcome of mental suffering is a sure fire way to keep it alive. Depressed people need to be selfish, but an act causing so much unnecessary harm isn’t necessary.

I don’t like to talk about my own mental health background publicly, but sadly in these debates it’s the only way to get a pass into the conversation. I’ve tried to take my own life, and was shocked and uplifted when people came and helped me to restart my life in the aftermath.  When I posted some initial thoughts about this on Twitter I received a message from someone I used to know over Facebook, hur ling abuse at me for suggesting suicide attempts could be selfish. When I disclosed my history to them their shit couldn’t crawl up their arse quickly enough.  It wasn’t irritating because they hurled abuse at me; some opinions are awful enough to have abuse directed toward them. What was irritating is the validity of my opinion changed because I revealed a part of my personal history, because I was suffering from some sort of disease I had to be pandered to. Even if my opinions were wrong, I had to be treated as a delicate flower.

To put a cringeworthy spin on a trite quote:  I am not a disease. I am a free man.  A diagnosis of mental illness should stimulate empathy and understanding, but it doesn’t put you outside the obligations to others everyone else should too abide by.  Some mentally ill people may feel better  perceiving themselves as victims- it’s your choice, but you must accept this self imposed identity is a choice. Choice, whatever people may say, isn’t the sole preserve of the healthy.

Can we please stop the tired trope of Tories hating the mentally ill?

Mental health, just like any other form of health, is a serious complicated business. Certain treatments will work, others will not, and in some cases it will deepen the symptoms a person is facing. We also know in any clinical treatment there are matters of ethical consent which need to be given. It’s more than fine to criticise someone in the Department for Work and Pensions for flying a kite for the idea those suffering from mental conditions should have their social security linked to their adherence to treatment.

The problems are well covered in this article over at the Guardian by Pete Cashmore. In short, CBT is not the panacea it’s thought to be – talking therapy is often triggering, and SSRIs often leave sufferers with side-effects that worsen – at least in the short-term – their condition. The article is reasoned quite well, until it moves on to the idea the Tories are in on a conspiracy to shame and make people suffer.

Pete’s piece isn’t the only one which does this, nor is it the worst. All of the noises from the online mental health community say the same thing in a more direct and tin-hat way. In short, it’s nonsense. The refusal to see a difference between someone being wrong is in part the reason why mental health is so shoved down the list of priorities by officials. Coincidentally the mental health blogger Sectioned ran a great conversation over Twitter after the story settled down asking people to reveal what they wish would people would say to to them in their situation. S also made a revealing comment over how many people don’t say anything at all because they might say the wrong thing, and what a shame this was. Strangely enough, this attitude goes out the window when Tories are involved.

Personally, I’d rather take the Tory source at their word when they say they want to help people with mental health conditions. Yes, it is a national disgrace there are so many people left on benefits without treatment. Yes, they could be forgiven for thinking CBT is all it takes given the national fanfare it’s been given by mental healths most prominent advocates. Yes actually, it is a disaster taxpayers are picking up the bill for our policy of sectioning off a subset of society onto permanent benefits. Yes, their idea of tying it to benefits is completely inappropriate. We all know it’s the long waiting lists which are the main barrier to treatment, but if we want to put words in the sources mouth then we could generously see this as a commitment to roll out a vast amount of treatment.

Should we? No, because choosing peoples meanings for them is a stupid idea. What we know about so far is the creation of the pilots to integrate treatment with receipt of benefits, which incidentally is a fantastic idea and should be applauded. This is the party that created parity of esteem between mental health conditions and physical conditions because it understood that the two can be linked.

Whatever you think about waiting lists in general, the addition of them to waiting list targets from next April to should be commended. But this doesn’t translate for people who suffer from a clinical condition of Toryitus.

The desire to help people from this source though is completely clear, and it’s a good thing people in senior positions are starting to, and wanting to, grapple with the tragic position a lot of us are in. There’s so much interest certain group of influential Tory MPs who want to make mental health a cornerstone of their election manifesto.

Are these people just a group of pathologically evil “Tories” who dedicate their political career to tramping on the minds of the people they represent? No. Like most people in politics when  they tell you something, they are being honest in what they say, and they mean it to their literal word. A lot of the time they’re going to be wrong, so sometimes they’ll need to be nudged along in the right direction. Purposely hounding them away because they might say the “wrong” thing is the reason so many people will be sectioned from politics forever.

Let’s talk about depression.

Recently, Giles Fraser published an interesting article about the way in which we approach the issue of mental health. Interesting – but almost entirely uncontroversial. The response was pretty much unanimous. There was no debate. Fraser was condemned for his ignorance, condemned for his callous attitude, and dismissed. His dismissal, I allege, was both unfounded and unjust. It was also symptomatic of a growing problem with the way in which we approach this topic as a whole.

 

An emerging phenomenon in well-meaning, apparently ‘progressive’ circles is that discourse around mental health has shifted away from the idea that we ought to understand causes of depression. It has shifted away from inquiring about the extent to which depression exists, and away from asking what solutions to the problem we possess. It has shifted away from asking how far we should be sceptical towards those who claim to know everything on the subject, be those the sufferers themselves or doctors and pharmaceutical companies.

 

Instead, what has been adopted is the idea that depression is some kind of disease. We man the barricades against those we feel might contribute to any stigmatisation of sufferers at all. In the name of protecting the “victims” from perceived slights, we have decided to shut down discourse altogether. Whilst I am entirely open to disagreement, my own experience in various mental health communities suggests that we seem to have reached a state where sufferers are wont to wear their “disease” as some kind of badge of honour. Pride in overcoming something awful has become pride in simply experiencing something awful. Whenever journalists like Fraser contribute something to the debate, the insistence is that he has no knowledge of mental health – doesn’t he know the science? As someone who hasn’t experienced the terrifying blackness of depression, what right does he have to write on it?

 

Well, actually, fellow sufferers: you know nothing. I know nothing. The current medical profession knows very little. It may well be the case that the voice of those who suffer has been stifled for too long, but it is worse than ignorant to suggest that you alone now hold the answers. The individual experiences of what we call mental illness are so diverse, so intensely private and personal, that to form “communities of understanding” through which external responses can be quashed is both naïve and dangerous. In a situation where we know so little about mental health, any external voice – such as Fraser’s – which might contribute to our understanding is to be welcomed. However difficult and painful it may be, the reintroduction of robust standards for discussion is indispensable if we are to progress even slightly in this field.

 

Now that my small diatribe about mental-health discussion is over, I want to move on to dissecting some of the points Fraser made in his article – points which are worth discussing, rather than being dismissed as though they were some kind of attack. Again, the perspective offered here is but one, and as subjective as any other, but stated in the interests of broadening and advancing debate.

 

The claim that drug companies have decided to fit existing chemicals into “normal” conditions is not just speculative emotional backlash. In Frasers’ case, we deal with the Christian argument against the ‘unnaturalness’ of using pills to treat the human condition. This approach is not just confined to religious groups: Harvard, for instance, has conducted many symposiums on what is termed the “medicalisation” of society, and the role of capital in driving this. The condemnation of this medicalisation has also come from the accounts of those who have been mental health professionals. Also of note in the above piece is the massive shift from doctors’ prescription of talk therapy to the prescription of anti-depressant drugs. When we place our emphasis on causes rather than symptoms of depression, this shift visibly demonstrates the NHS’ complete failure to deal with mental health issues, and its increasing reliance on what is seen as a simple, trouble-free solution.

 

The fact we have these supposedly-easy solutions is one reason why the NHS, and the rest of society as a whole, is saved from ever having to confront actual causes of despair. The demand on mental health sufferers is simply to adapt to this shift; aided through the quick prescription of SSRIs or some substitute. In fact, the prescription of pills and the claim that these “help people get back on their feet” is likely to do more to enhance the perception of blame upon the individuals involved. This medication will redeem the chemical imbalance within you, we are told, and if you still can’t adapt after that? Well, then, it is no structural problem but a real personal failing. This approach stands in lieu of open and robust discourse about causation, and it is silencing. It is repressive. When we are miserable, it doesn’t matter whether or not it is a disease. All that matters is the abject malaise and unhappiness to which we are, crushingly, subject.

 

Until our reactionary mentality is dropped, and we can progress from treating the discussion as a battle – a fight to the death between Them and Us, between those who understand and those who do not, even between what is right and what is wrong – we will be stuck in inertia. Our task is to look at the means available for the reduction of human despair. This is the only way in which progress might, finally, begin to emerge: progress not just for those who suffer with poor mental health, but progress for society as a whole.

 

A shorter version of this article is here at Nouse.