"It's easy to write prescriptions. It's hard to come to an understanding with people" - Kafka, A Country Doctor
As somebody who has long argued that mental distress should not be regarded as 'illness', I've been heartened by the expression of some heretical perspectives on mental health in certain sections of media recently. The big story at the moment is that the Division of Clinical Psychology of the British Psychological Society has called for a 'paradigm shift' in thinking about mental health - a shift that would replace the currently dominant, biomedical approach to mental illness with one that seeks to understand psychological distress in relation to the social and personal difficulties experienced by sufferers.
Moves in this direction certainly make a lot of sense. Quite simply, the medical model of madness lacks credibility. For one thing, it has failed to generate adequate diagnostic criteria for specific 'mental illnesses'. Indeed, the incoherence of the diagnoses such as schizophrenia and bipolar disorder are widely acknowledged. As the psychologist Elie Godsi writes of psychiatric diagnoses in his book Violence and Society:
"Countless attempts to define particular illnesses through obsessively detailed descriptions have failed to achieve anything like acceptable levels of consistency. In any other branch of science this level of unreliability would have led by now to the abandonment of the original concept and a search for another"
Nor can conditions such as depression be said, in any straightforward sense, to have physical causes; rather, there is compelling epidemiological evidence that the psycho-social problems experienced by sufferers play a key role in their onset. As Dr Lucy Johnstone puts it in the article linked above, 'there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse'. And as if all this weren't enough, the validity of the biologistic account of mental illness is further undermined by the paucity of evidence for the efficacy of pharmacological intervention. Crudely put, the drugs don't work - and the clearest beneficiaries of many psychiatric medications are not patients, but pharmaceutical companies.
Unfortunately, however, the message most commonly communicated in the media - particularly on television - is that the various forms of mental distress should be regarded and treated, like cancers, as biological illnesses. In a recent package on BBC's Breakfast News, for example, mental health campaigner and former Labour spin doctor Alastair Campbell repeatedly emphasized that mental problems are idiopathic illnesses that can strike anybody at any time. Campbell also argued that the acceptance of this biological perspective by sufferers helps to remove the stigma of mental ill-health and can be the first step towards recovery. This, too, is a highly debatable point: there is high-quality research suggesting that regarding mental distress as an 'illness like any other' actually increases stigma and is linked to worse outcomes.
It might be added that there is something quite problematic, for many of us, about listening to a figure such as Campbell - who played a key role in building the British state's justification for the bloody invasion of Iraq - talking of the need for human understanding and compassion. In recent years it has become more common for politicians and other high-profile figures to 'speak out' about mental distress (the Conservative MPs Charles Walker and Sarah Wollaston are the latest to have done so). Yet while it is undoubtedly 'good to talk' about mental health, we ought perhaps to be wary of the motives of powerful individuals who present themselves - or are presented by others - as 'victims'. Winston Churchill famously struggled with the 'black dog' of depression; but our sympathies with Churchill's suffering should not blind us to the oppression and racism that characterized his political outlook.
As somebody who has long argued that mental distress should not be regarded as 'illness', I've been heartened by the expression of some heretical perspectives on mental health in certain sections of media recently. The big story at the moment is that the Division of Clinical Psychology of the British Psychological Society has called for a 'paradigm shift' in thinking about mental health - a shift that would replace the currently dominant, biomedical approach to mental illness with one that seeks to understand psychological distress in relation to the social and personal difficulties experienced by sufferers.
Moves in this direction certainly make a lot of sense. Quite simply, the medical model of madness lacks credibility. For one thing, it has failed to generate adequate diagnostic criteria for specific 'mental illnesses'. Indeed, the incoherence of the diagnoses such as schizophrenia and bipolar disorder are widely acknowledged. As the psychologist Elie Godsi writes of psychiatric diagnoses in his book Violence and Society:
"Countless attempts to define particular illnesses through obsessively detailed descriptions have failed to achieve anything like acceptable levels of consistency. In any other branch of science this level of unreliability would have led by now to the abandonment of the original concept and a search for another"
Nor can conditions such as depression be said, in any straightforward sense, to have physical causes; rather, there is compelling epidemiological evidence that the psycho-social problems experienced by sufferers play a key role in their onset. As Dr Lucy Johnstone puts it in the article linked above, 'there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse'. And as if all this weren't enough, the validity of the biologistic account of mental illness is further undermined by the paucity of evidence for the efficacy of pharmacological intervention. Crudely put, the drugs don't work - and the clearest beneficiaries of many psychiatric medications are not patients, but pharmaceutical companies.
Unfortunately, however, the message most commonly communicated in the media - particularly on television - is that the various forms of mental distress should be regarded and treated, like cancers, as biological illnesses. In a recent package on BBC's Breakfast News, for example, mental health campaigner and former Labour spin doctor Alastair Campbell repeatedly emphasized that mental problems are idiopathic illnesses that can strike anybody at any time. Campbell also argued that the acceptance of this biological perspective by sufferers helps to remove the stigma of mental ill-health and can be the first step towards recovery. This, too, is a highly debatable point: there is high-quality research suggesting that regarding mental distress as an 'illness like any other' actually increases stigma and is linked to worse outcomes.
It might be added that there is something quite problematic, for many of us, about listening to a figure such as Campbell - who played a key role in building the British state's justification for the bloody invasion of Iraq - talking of the need for human understanding and compassion. In recent years it has become more common for politicians and other high-profile figures to 'speak out' about mental distress (the Conservative MPs Charles Walker and Sarah Wollaston are the latest to have done so). Yet while it is undoubtedly 'good to talk' about mental health, we ought perhaps to be wary of the motives of powerful individuals who present themselves - or are presented by others - as 'victims'. Winston Churchill famously struggled with the 'black dog' of depression; but our sympathies with Churchill's suffering should not blind us to the oppression and racism that characterized his political outlook.
But to return to the main point: the mainstream media bears a heavy responsibility for hegmonizing the biomedical paradigm. Consider, for example, the role played by the media in 'condition branding', the process by which psychiatric conditions are introduced into the public sphere and normalized by influential personalities: most famously, in 2002, the football player Ricky Williams appeared on the US talk show Oprah to talk about his shyness, but few viewers were aware that the pharmaceutical company GlaxoSmithKline - whose Social Anxiety Disorder drug Paxil became the company's best-seller - was paying Williams to do so.
Here in the UK, meanwhile, many well-regarded television documentaries in recent years, including Campbell's own Cracking Up (BBC, 2008) and Stephen Fry: The Secret Life of the Manic Depressive (BBC, 2006), have placed a heavy emphasis on the biopsychiatric view of madness as illness. Considering the political conservatism of both Campbell and Fry (who responded to the 2009 MP's expenses scandal by reassuring the public that the dishonesty of a few rotten apples shouldn't cause people to lose faith in parliamentary democracy), we shouldn't perhaps be surprised at this unwillingness to contemplate the psycho-social contexts of madness. But it certainly would be good to see the Division of Clinical Psychology's criticisms of biopsychiatry reflected more widely in the media; this might pave the way for a more rational and context-sensitive public discussion of mental health.
Here in the UK, meanwhile, many well-regarded television documentaries in recent years, including Campbell's own Cracking Up (BBC, 2008) and Stephen Fry: The Secret Life of the Manic Depressive (BBC, 2006), have placed a heavy emphasis on the biopsychiatric view of madness as illness. Considering the political conservatism of both Campbell and Fry (who responded to the 2009 MP's expenses scandal by reassuring the public that the dishonesty of a few rotten apples shouldn't cause people to lose faith in parliamentary democracy), we shouldn't perhaps be surprised at this unwillingness to contemplate the psycho-social contexts of madness. But it certainly would be good to see the Division of Clinical Psychology's criticisms of biopsychiatry reflected more widely in the media; this might pave the way for a more rational and context-sensitive public discussion of mental health.
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