Too many pills

Patients Waiting to See the Doctor, with Figures Representing Their Fears
Rosemary Carson (b. 1962)
Photo Credit: Wellcome Collection [CC BY] 

... This week researchers at University College London who analysed decades of research concluded that there was no convincing evidence that depression is associated with, or caused by, lower serotonin concentration. (chemical imbalance)

The study hardly surprised James Davies, an academic who has long assailed what he sees as the alarming trend of over-diagnosing and over-medicalising mental distress... He is especially concerned at how prescriptions have soared while our mental health has not improved.

"Here is a study showing what we've known for a long time, which is that depression isn't caused by chemical imbalances," he says. "This was a piece of mythology, which was was very useful for the pharmaceutical industry to deploy to legitimate use of their products. SSRI antidepressants." (It should be noted that other experts say that antidepressants are effective, even if it is not clear how they work.) 

... Davies says patients are being sold a narrative that is "stigmatising and pathologising and over-medicalising and underplaying the extent to which people's problems are natural reactions to bad things that are happening in the present or the past."

Depression is not the only illness Davies believes is over-medicalised. This year the "bible" of American psychiatry identified a new disorder. Those who are still suffering from intense and debilitating grief a year after the loss of someone they love can now be treated for prolonged grief disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)...

"We will all agree that some people experiencing long-term grief could benefit from social support and understanding and care - to offer that is just human," Davies says. "what feels decidedly anti-human is pathologising this experience as a kind of psychiatric disorder that requires psychiatric treatment."

He is concerned that a drug used to treat addiction is undergoing trials for use as a therapy for grief. "We're medicalising a natural and understandable human reaction to loss. This is just the latest example of a problem we've been seeing unfolding sine the 1980s. We have been dramatically over-medicalising natural and understandable human reactions to the difficulties of living, reclassifying them as psychiatric disorders amendable [by] psychiatric interventions."

In the 1980s, he says, the DSM listed over 100 mental disorders. Now the figure is about 370. "We've also progressively lowered the bar for what constitutes having one of these disorders, which in effect has expanded the definition of mental illness to encompass ever more domains of human experience."

... In England about a quarter of adults are prescribed dependency-forming drugs each year, with 17 per cent taking antidepressants. Prescriptions for antidepressants have almost doubled over the past decade.

... Suffering, Davies says, has been turned into "a kind of vibrant market opportunity".  He also believes that treatment of mental health has become focused on fixing something wrong with the individual that needs to be fixed, rather than looking at the "social predicaments" they are in.

(Damian Whitworth, The Times, 2022)

Lucy Foulkes, 33, whose career is in academic psychology and who is at present attached to University College London, recently asked an undergraduate student how her friends discussed their moods. "She said everyone in her year group - more than a hundred students - self-identified as having depression or anxiety disorder or both."

Foulkes was so struck by this that she had to try and understand it. Even with an expanding diagnostic definition of these illnesses, only a small minority of students would, statistically, meet the criteria for clinical depression or anxiety. Instead they were doing what so many of us, seem to be doing, "liberally applying the psychiatric terminology that is now commonplace in our culture to more transient or low-level unhappiness or worry", as she writes in her new book, Losing Our Minds...

Beata Beatrix
Dante Gabriel Rossetti (1828-1882)
Photo Credit: Tate [CC BY-NC-ND]

"Hang on, who is this conversation about mental health helping if the outcome is that everyone is interpreting their experiences as anxiety and depression ?"... a broad mid-range of normal human emotions have been medicalised. People are "OCD" when we mean tidy or have PTSD after a visit to a smelly pub lavatory.

"The medicalisation of what should be considered normal helps no one. All forms of psychological distress are the price we pay for being alive... Let's not add to our suffering by worrying that there is something wrong with us for feeling bad."

This is a book that calls for nuance in answering difficult questions. For example, are mental health disorders soaring to "epidemic" levels, as we so regularly hear? They are not she concludes...

"It's like survivor guilt," she says "You're not allowed to say 'I'm fine'. It's almost like you're supposed to be depressed right now. It's not true. The majority of people have not taken a hit to their mental health in the last year. That doesn't mean no one has - some individuals and groups have - but the message gets simplified to the pandemic causing a mental health crisis."...

Alongside medical evaluation, if necessary, she advocates for a deeper and more philosophical awareness of the cycling weather of human moods, that sadness and worry will always be with us and we can learn ways to manage them. It is wrong and offers the young generation false hope, to suggest that these emotions are illnesses, because they cannot be treated in the way an illness can...

(Helen Rumbelow, The Times, 2021)

The medicalisation of what should be considered normal has become big business especially in the United States. There, drug companies with the help of some medical professionals now attribute, for example, shyness as social phobia.

*Lucy Foulkes' article struck a chord with me. As a listening volunteer for a local hospice, I support patients, carers and bereaved families, and I have lost count of the times I have been asked, "Am I going mad?" by bereaved relatives. Very occasionally, some degree of depression may be present, but almost always the answer is, "No, you're just very sad". Because as a culture we talk so little about bereavement and loss, people are often unprepared for the sheer disabling power of grief, and assume they must be mentally ill. We need to talk more openly if people are to be equipped to recognise, manage and if necessary, seek help for the impact of the events and emotions that most will encounter in a normal life.

(Jill Wallis, Aston Clinton, Bucks, The Guardian, 2021)

*Some years ago, during training to become a social worker, our tutor asked us to list as many symptoms of mental illness that we could think of. She then asked us to identify any of these symptoms that we personally had not experienced. It quickly became clear that we had all been affected by most, if not all, of these at some time. It is chronic or persistent symptoms that require intervention from mental health services.

(Michael Wild, Postbridge, Devon, The Guardian, 2021)

Wellbeing Obsession

An English teacher called Dawn Wilson-North was interviewed on Radio 4's PM last Thursday... She was fed up with hearing how children weren't learning anything: her pupils were learning just fine, and online attendance was at 90 per cent, not much lower than normal.

"When you look at them as young people going out into the big, wide-world, particularly year 11s, they're going to have gained so many skills from what they're doing. They're learning self-reliance: they have to be there, work the technology, use the technology that adults are using. They help each other in the chat; they copy links if people can't quite get on. They're learning resilience. These are all employability skills that they're going to be well up to speed on in a way that perhaps other students wouldn't be." Her pupils, she said, were sitting in virtual classrooms for six hours a day, doing their lessons, doing their homework, participating, engaging. What they found demoralising was the narrative from adults that this all added up to a giant failure.

Anxiety, Head of a Girl
Jean-Baptiste Greuze (1725-1805)
Photo Credit: Victoria Art Gallery [CC BY-NC-ND]

On Friday morning's Today programme the presenter talked to some students about how they were feeling. "We're calling them the Covid Generation," he said sadly, as though their granny had just died... enough misery chat about how Covid is affecting young people's education and future prospects! What happened to the idea of parents putting on a brave face and being can-do-ish and upbeat? No wonder teenagers are depressed: things are weird enough without adults feeling perfectly OK about going, "Poor you - this is an absolute disaster. You're part of a lost generation - it is the most tragic waste."

Of course everyone feels very sorry that some teenagers' mental health is suffering, but I don't know that endlessly telling them how awful things are for them is helping...

Any parent should be wary of encouraging a child to think of themselves as an external victim, a thing with no agency: these are not good foundations for emotional wellbeing... And what has happened to the idea of promoting resilience? It is the most discredited of qualities, because it has wrongly become equated with a sort of emotionally disengaged, dead-eyed, stiff-upper-lip kind of attitude to life, and no one wants that. But resilience is good. It's what gets you through stuff...

Mixed in with all this is the unhelpful fact that the phrase "mental health" has become close to meaningless because of our obsessive desire to pathologise every possible emotional state, especially when it applies to children and young people. We should really row back a bit from medicalising feeling anxious, bored, lonely, worried, cross, annoyed, confused. Everyone cycles through these feelings - along with some jollier ones - for the whole of their lives. They are not indicative of poor mental health...Feeling worried, sad or hacked off is not mental illness, any more than a headache is a brain tumour...

(India Knight, The Sunday Times, 2021)

 Thank God for a reflective, perceptive and pertinent piece of writing. Coping with the  challenges, problems and setbacks you will inevitably meet during the course of your life, including this pandemic is essential. It's called resilience.