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.