 ‘We have pretty much come to accept the view that normal emotional reactions to life events like unhappiness, sadness, anxiety or mourning are pathological and indeed correctable with the right combinations of pills.’ (Eugene Epstein) I’ve had some pretty eye-watering conversations with mental health experts recently, ranging from psychotherapists and nurses to social prescribers and those with diverse lived experiences. A recurring theme of concern is the over-diagnosis of mental health conditions, combined with the over-prescription of medication as a solution. The former is creating what Kenneth Gergen calls ‘a diseasing of the population’, and the latter a world of mental health drug addicts. Yet how did we get here and what is driving these trends? It’s a complex picture: e.g. the prevalence of a medical (rather than social-psychological) model to explain and address mental health issues; a quick-fix culture that believes taking meds is faster and easier than therapy or radical lifestyle change; concerned GPs who don't have access to alternative support, or sometimes find it less stressful to prescribe meds than convince demanding patients they don’t need them. Added to this, the week after Gavin Francis published his insightful book, The Unfragile Mind, Lucy Foulkes wrote a thoughtful article, Are We Really Overdiagnosing Mental Illness? She comments that, increasingly, ‘individuals are labelling their own mild or transient life problems with the language of disorder.’ In other words, we are seeing a growing culture of self-diagnosis. (The language of disorder echoes Jo Watson’s compelling books titled, Drop the Disorder). Taking a compassionate position, however, Foulkes also proposes that the rise in mental health diagnoses is likely influenced by a corresponding rise in mental health awareness in the public arena (something to be welcomed); and a possibility that psychological distress really is on the rise for some individuals and groups in society (something to be concerned about). She ends with a word of caution: ‘If a person tells you they are struggling, you should believe them.’
10 Comments
 ‘When they believed the lie, the lie became truth for them.’ (Selwyn Hughes) I will never forget that flash of insight at a Christian counselling seminar. Selwyn Hughes was talking about risks of deception and self-deception and used the biblical story of Adam and Eve (and the serpent) to illustrate his point. If I genuinely believe something to be true that isn’t true, it will nevertheless appear true to me. Insofar as it appears true to me, I’m unlikely to question it. If my peers or wider cultural group also believe it to be true, that will likely reinforce my belief. This came to mind recently when chatting with some young adults about the state of mental health in their generation. In an era where, increasingly, what would have been hitherto regarded as the normal human condition (e.g. ups and downs in life; quirky attitudes and behaviours; feeling anxious, stressed or in a low mood) are now regarded as pathological mental health conditions, we wondered together what lies may appear true to them and who might benefit from them. Take, for instance, the young woman who looks at the ways in which peers present themselves on social media. By contrast, she feels inadequate, insecure or a failure. Her expectations and emotional experience are influenced by what she perceives as ‘normal’, and she feels anxious and starts to avoid social contact. A well-meaning medic tells her she has Anxiety and prescribes medication to help her feel better. The label provides an explanation and, thereby, a kind of relief. Yet, she may have unknowingly swallowed more than just the meds. The diagnosis subtly traps her and, over time, begins to shape her personal and social identity: ‘I have Anxiety. That’s why I feel anxious. It’s who I am.’ Her world gets smaller as she acts out what she now believes to be true. She thinks she is defective, that she needs to be fixed, and not that her feelings are a natural – perhaps, even healthy – response to, e.g. dysfunctional background, toxic environment or maladaptive lifestyle. The lie became truth for them. What do you believe? ‘The global mental illness drugs market size is predicted to grow from US$1759 million in 2025 to US$2497 million in 2031.’  ‘It is the obligation of every person born in a safer room to open the door when someone in danger knocks.’ (Dina Nayeri) Reading Gill Martin’s insightful book, ‘Borders and Boundaries – Community Mental Health Work with Refugees and Asylum-Seekers’ has been an illuminating experience. It resonates well with some of the issues and dynamics I have witnessed too, albeit outside of the therapeutic arena. I remember when, after a long and agonising wait, a Kurdish-Iranian friend in the UK was granted refugee status. It meant that, finally, he could bring his wife over to join him and he could get a job to fulfil his passion and potential as a gifted architect. His pent-up talents had opportunity for release and he’s now making an outstanding contribution at an architects’ firm. Gill comments on the need, at times, to cross (not violate) what may be regarded as fixed professional boundaries, to meet refugees and asylum seekers at their point of need. She draws attention to the therapeutic meaning, significance and value of being-with, of being-alongside, in authentic human relationship. Much of our sense of identity is founded on e.g. our country and culture of origin; the groups and communities of which we are a part; our shared experiences; the work and roles we fulfil. When forced to leave all we associate with home to flee to a starkly different culture and environment, it can feel isolating relationally and dislocating existentially. Gill observes that talking therapies have their place but aren’t always what refugees and asylum seekers want or need. Sometimes, it’s because they come from cultural backgrounds that hold very different beliefs about health and wellbeing, including what influences, nurtures, sustains or harms it; or, perhaps, cultural taboos that would deem seeking and receiving help of this kind to be shameful. Sometimes, interventions akin to social prescribing, involving people in activities that they experience as worthwhile and life-giving, can be beneficial. Health and healing often emerge through enabling powerless people to regain a sense of agency over their own lives. (Further reading: Working with Asylum Seekers and Refugees: What to Do, What Not to Do, and How to Help; Counselling and Psychotherapy with Refugees; A Practical Guide to Therapeutic Work with Asylum Seekers and Refugees; Refuge: Transforming a Broken Refugee System; Strangers in our Midst: The Political Philosophy of Integration)  ‘The medical model doesn’t perfectly fit mental health – and it confuses a lot of people.’ (Emma McAdam) Is mental health all in the mind? I don’t think so, but I do believe we’re sometimes getting a bit lost in how we think about and approach it. Take Sam. He’s 27, talented and full of potential. Yet Sam often finds himself these days feeling jittery and irritable and struggling to concentrate. His partner finds his mood swings and erratic behaviour increasingly difficult to cope with. Feeling concerned, she took him recently to see his GP who referred him for a mental health assessment. The assessor asked Sam briefly over the phone to describe his symptoms, diagnosed his state as ADHD and recommended prescription medication to resolve it. Now step back with me for a moment. Consider human factors that lead to a sense of mental, emotional and physical well-being, and which can influence a corresponding felt-experience of unwellness if persistently absent in our lives. Things such as: safety and security; sense of purpose; engaging in positive and meaningful human relationships; ability and opportunity to exercise free choices; feeling of making a valued contribution in the world, especially for the benefit of others; achieving something worthwhile; fresh air; change of scenery; prayer, intimacy; sex; physical exercise; personal hygiene; laughter; diet; sleep; rest. Sam stays mostly indoors; sleeps until mid-afternoon; rarely washes; spends all night, every night, playing intense computer games; eats junk food; lives on high-caffeine energy drinks. He did have a job for 2 weeks at a call centre but resigned because he felt unhappy dealing with customer complaints. He has now been unemployed for some time and lives on state benefits. From a psychological and relational perspective, we could view ‘feeling jittery and irritable and struggling to concentrate’ as natural outcomes of Sam’s lifestyle choices, not as a pathological dysfunction requiring medication. Social prescribing could be a healthier response.  ‘Language is power, life and the instrument of culture, the instrument of domination and liberation.’ (Angela Carter) In her challenging and ground-reclaiming polemic, Drop the Disorder, psychotherapist Jo Watson comments that, “The counselling profession (and in that I include psychotherapy) is helping to endorse a medical understanding of emotional distress that is based on ‘What is wrong with you?’ and not ‘What has happened to you?’” I heard a similar-but-different reframing of the issue from Paul Kelly at a Leading & Influencing Trauma-Informed Change workshop today, advocating a shift from “What’s the matter with you?” to “What matters to you?” The striking feature of both these examples is the profound impact of language on reflecting and reinforcing the ways in which people and situations are construed and responded to. In Jo Watson’s case, the first framing regards an issue as some form of dysfunction in an individual. The alternative looks beyond the individual to explore wider potential influencing factors. As radical social reformer Martin Luther King noticed, what appears at first glance as dysfunctional behaviour is sometimes a normal response to dysfunctional circumstances. In Paul Kelly’s case, similarly, the first framing locates a problem within an individual. It’s a form of pathologizing, implying that a person’s behaviour is a consequence of some internal defect. The alternative invites an exploration of the person’s underlying values and motivations. Behaviour that appears dysfunctional could be a natural response to healthy, unmet hopes and needs in a dysfunctional environment. Kenneth Gergen offers a stark warning here, pointing to risks of a medical model applied uncritically: ‘a diseasing of the population.’  ‘People get tired of asking you what's wrong and you've run out of nothings to tell them. You've tried and they've tried, but the words just turn to ashes every time they try to leave your mouth. They start as fire in the pit of your stomach but come out in a puff of smoke. You are not you anymore. And you don't know how to fix this. The worst part is...you don't even know how to try.’ (Nikitta Gill) Losing my voice was a painful experience. It started with frequent sore throats and laryngitis but steadily got worse. After a while, I had to suck on throat lozenges to be able to speak at all. My voice became very weak and, if I had to project it in a group or tried to sing, it felt afterwards like I’d been garrotted. Feeling increasingly concerned, I saw my doctor who referred me to ear-nose-throat specialists. They ruled out throat cancer and vocal cord nodules yet still couldn’t work out what was causing the problem. I lost count of how many cameras they ran up my nose and down my throat. As time went on with no improvement, they referred me to speech therapy. By now I was having to carry a sign at work to say, ‘Sorry, I’ve lost my voice’ and a clipboard to write down what I wanted to say. (It was amusing to see how many people wrote down their responses for me to read too. I had after all lost my voice, not my hearing.) The speech therapists were puzzled by the symptoms and tried various techniques without success. For 2 years, I virtually couldn’t speak at all. It took another 10 years of cameras and speech therapy before they finally worked out the underlying problem. Bizarrely, I had somehow learned to speak as a child without using the complex muscles around the larynx correctly. It was, in effect, as if I had found a way to imitate normal speech. That was OK to a point, until my work demanded more strenuous use of my voice. That’s when it became strained and failed. Apart from the intense physical discomfort, the social and psychological effects were profound. Over the years, I got tired of explaining my predicament. I became far quieter than usual and people related to me as if I was incredibly introverted, or simply didn’t relate to me at all. It became so very isolating. Not only did I lose my physical voice. I felt steadily as if I was losing my personal identity, presence and influence in social situations too. I felt helpless to resolve it and had no idea if it could or would ever be resolved. Salvation came in the form of a new friend, David, whom I met in a church and who had suffered from debilitating hearing loss for many years. When he described the social and psychological effects it had had on his life, for the first time I didn’t feel alone. It demonstrated the power of empathy and its place in healing. Now I could learn to speak. That was a scary moment. My Dad had developed a dangerous arrhythmia and drastic action was needed to save his life. Paradoxically, the solution lay in stopping his heart. After what felt like a breathtakingly-long pause, the cardiologist restarted his heart to re-establish a healthy rhythm. Thank God it worked and we could all breathe again. More recently, my laptop got into a mess. It was operating so slowly and experiencing so many glitches that I wondered if I needed to replace it. An IT trainer friend, Rob, had a look and discovered that, for some time, I had been closing the lid to power it down, rather than turning it off-and-on again to reboot it. He restarted it and then it worked. A teacher friend, Kathrin, commented that people professionals who deal with challenging relationships, complex issues and wicked problems can get into a tangle too. Over time, it can feel harder to see the wood for the trees, a bit like having pressed on day-after-day without sleep. If you're feeling stressed or burned out, you need a restart. Curious to discover how I can help? Get in touch!  'Diagnosis determines intervention.'
There’s a very big difference between ‘What’s wrong with you?’ and ‘What’s happened to you?’ Jo Watson’s book, Drop the Disorder (2019) is a timely and courageous personal-professional challenge to the creeping influence of the biomedical model into social-psychological therapeutic thinking and practice. In her aptly titled article in the book, ‘There’s an intruder in our house!’, she reflects with a pained air of near-despair on this gradual, alarming and depressing diagnostic drift: ‘It wasn’t always like this. I joined a profession that held a shared belief about the nature of human emotional distress. We understood that the many forms of human suffering we witnessed – ranging from feeling low and suicidal to self-injury, hearing voices, overwhelming anxiety and dissociative experiences – were responses and reactions to what had happened in people’s lives and, in many cases, the resourceful and creative coping strategies they had developed to survive. We clearly and consistently made links between emotional distress and causal factors like poverty, racism and abuse. There was a deep, collective ‘knowing’ that social circumstances were linked directly to human suffering and this acknowledgement translated into a connection with the political arena. Yet, as I write, this work has been consumed by a biomedical monster that has crept into our house and made itself very much at home. In fact, I don’t feel this is my home anymore.’ Jo is challenging a fundamental risk of the biomedical therapeutic model, that it locates a perceived problem in an individual, irrespective of a broader context. In doing so, Jo echoes disaster management expert Marcus Oxley’s insight (in a different arena) that, if we see a pattern of symptoms in people attending an Accident & Emergency unit, it may well reveal something implicitly about conditions in that context. It’s always about the person, but it’s rarely only about the person.  'The reality is that you will grieve forever. You will not 'get over' the loss of a loved one; you will learn to live with it.' (Kubler-Ross & Kessler) At 15, I was fatally wounded. At 18, I died. That’s how it felt and, at times, it still feels now. There are some scars that never heal. A trauma of unwelcomed loss is being forced, harshly, to let go of an imagined future, a hoped-for dream. This tearing experience can leave our hearts, our bodies, bleeding. I felt betrayed and shattered and spent day after day, year after year, pleading with God to take my life. I slid into a heavy, dark dysthemia. Nothing could bring healing, happiness or hope. It's fertile ground for addiction, to search for anything that will make us feel alive, provide even momentary relief. We may immerse ourselves in whatever distracts and enables us to avoid having to face again, all too wearily, those severe memories and tortured feelings. My own torment was that searing-painful images would surface over and over in my dreams, as if trying to reconcile the suffering at some deep subconscious level, yet leave me waking the next day in suicidal mood. I wish there was a simple answer, a miracle cure. I live in a culture that holds out delusional promises and expectations of a pain-free, pleasure-filled possibility of a life. I live in a world where hurt and damaged people, more and more, seek solace and escape in drugs or other diversions. I find my spiritual hope in Jesus who (to me surprisingly, yet in a strange way reassuringly) carries the scars of crucifixion after his resurrection. Whatever I may go through now, this will not end in death. Over the years I have learned, and am still learning, how to live with my own scars rather than to attempt to bury, hide or erase them. I’m still, at times, ambushed by grief. It takes me by surprise and leaves me temporarily reeling. I’ve learned to be thankful and, gradually, to allow people and relationships to drift away rather than to cling so hard. I’ve learned to discern how pain triggered from the past can reveal someone or something important that I’m not noticing here and now. How do you deal with your scars? How do you help others to do so too? (Nick is a change leadership consultant and trainer for trauma-informed practice agency, Rock Pool) ‘I was so focused on what I had lost, that I lost sight of what I had found.’ (Jerry Orbos) Orbos, a priest, recounted a story of when, as a small child living in a very poor village, he attended a fiesta. It was a special, exciting party and he was thrilled to be given a balloon. Some moments later, he was given an ice cream too. He could hardly believe it. On taking the ice cream, however, he accidentally let go of the balloon which floated away out of reach. Looking up helplessly, Jerry felt completely distraught. His mother, noticing his distress, whispered, ‘Jerry – look at your ice cream’. A loss that impacts deeply can leave us feeling hurt, mesmerised, transfixed and paralysed. We may struggle to breathe, as if caught in a trance state and unable – or unwilling – to break free. We may notice this when a person loses, say, a relationship, job or home that really matters to them. ‘What do you need?’ offers valuable empathy and support. ‘What are you not-noticing?’ can help break the gaze; enabling someone to see people, relationships and resources that lay hidden in plain sight. How do you help people to let go of what is lost? How do you help them to see what they can’t see? |
Nick WrightI'm a psychological coach, trainer and OD consultant. Curious to discover how can I help you? Get in touch! 
Like what you read? Simply enter your email address below to receive regular blog updates!
|
RSS Feed