The Big Story mental health

A healthy mind in a healthy society

Beyond pills and therapy, there’s a vast, unexplored area of promise for our mental health. Dinyar Godrej on the need to make individual recovery a social concern.

P h o t o g r a p h y

H a r v e y

Sitting in the waiting room of a busy psychologists’ practice in Rotterdam, I’m intrigued by the furtive nature of the experience. People waiting for their 50 minutes of focused talk avoid each other’s eyes, acknowledging each other with embarrassment, if at all. I could be in the waiting room of a sexually transmitted diseases clinic.

I’m a bit puzzled. With the increased familiarity of stress-related problems nowadays, shouldn’t this kind of guilt (no other word quite captures it) be a thing of the past?

Depression is so common that at times it has felt as if I had more friends who were battling it than weren’t. Various compulsive behaviours are constantly pored over by the media, often in an attempt to demystify them. With the advent of the internet there has been an explosion of mental health issues advocacy. Sound, down-toearth information is now easily available, perhaps excessively so. Surely we are better equipped than ever to view mental distress and illness as part of a continuum of our life experience, rather than as a site of stigma and taboo?

14 ● N ew I n t e r nat i o nal i s t ● MAY 2 012 The lived experience is, however, quite different. People with mental health problems still run up against a wall of unhelpful attitudes, ranging from ‘normalization’, which basically denies the problem, to an overly diagnostic attitude which sets the sufferer as a creature apart. Disbelief is in there, too, aided no doubt by a US-led tendency to classify an increasing range of common human behaviours and emotions – such as shyness or grief – as pathological disorders. The last things you want when confronting mental illness in yourself is to either let others define you by it or for them to deny it outright. Little wonder that people often feel that they find true understanding only among a community of peers.

The lack of empathy for mental illness can, of course, come from a fear of it; we have all had ‘dark tunnel’ experiences where we feel our grip on our lives is slipping. But there can be a more fundamental lack – the inability to come to terms with the infinite flexibility of the human mind and what it can experience. These words by Victorian poet Gerard Manley Hopkins haunt me with their truth:

‘O the mind, mind has mountains; cliffs of fall Frightful, sheer, no-man-fathomed.’

Bad chemistry Were the vistas of the mind easier to map, our imaginations a little less creative, would we be better at fixing things that go wrong? All the evidence of mental health ‘treatment’ suggests, however, that this is perhaps the most misguided question one could ask.

For it is often when we take fixed hypotheses as the point of departure that mental healthcare goes seriously wrong. Take the increasing belief that mental problems are due to chemical imbalances in the brain. A friend undergoing a major depressive episode was told by his general practitioner, after some cursory questions, that the cause was probably said chemical imbalance. An antidepressant drug was duly prescribed and day-to-day life became somewhat more bearable, but possible psychosocial triggers were left unexamined. A trajectory that will be familiar to many was set in motion.

Ten years along the line, the drug dependency is complete, while the effectiveness has diminished. As a result, a psychologist’s help has become an important support to this so-called ‘chemical’ problem. The drug has not prevented further depressive episodes (many people experience problems of increased gravity some years into medication), and no-one has any idea what the lifetime effects of the drug will be, because it is still too recent a discovery. Yet the doctor is convinced that it must be taken life long – as is my friend. Current estimates are that 1 in 10 US and Belgian adults are on antidepressants.

There is no doubt that medication does help many people who don’t have recourse to the other kinds of support needed to tackle depression. But drugs are as much a symptom of mental healthcare today as they are a proposed cure. And the question of whether there are better options (which, incidentally, may also include some degree of medication) tends to get silenced when the convenient pill is to hand.

John Mc Carthy, founder of Mad Pride Ireland, followed by Molly Buckley, Mayor of Tullamore, and supporters at a Family Fun Day in the town in 2010. Mc Carthy’s goal – to battle stigma through community, laughter and love.

Psychiatric survivors decry unfeeling ‘care’ by professionals and the chemical cosh of illconsidered medication

Expanding the market There is a growing stream of medications aimed at mental health ‘conditions’, and they are being marketed aggressively by Big Pharma. And why not, when the mental health system, even in wealthy countries, is in such a shambles that pills are seen as quick fixes and getting the right kind of help either involves running from pillar to post or a miracle. Insurers increasingly refuse to pay for talk therapies. In

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