The Medicalisation Of Resistance

With the bandwagon jumping skills that have got him where he is today, Nick Clegg has used conjunction of the Lib-Dem Conference and World Mental Health Day to announce that the coalition will spend the princely sum of £120 million over two years so that three-quarters of patients needing “talking therapies” for conditions such as depression will be guaranteed treatment in as little as six weeks, with 95% starting treatment after a maximum wait of 18 weeks.” By 2020 people suffering from psychosis will be offered treatment within just two weeks of referral! Clegg went on to say that, as compassion for those from suffering mental illness is a great liberal cause, he will to make mental health one of his party’s top priorities and commit up to £500m for a long-term programme to address the great unacknowledged illness of our time.

Mental health campaigners welcomed this significant advance in the treatment of the great unacknowledged illness of our time. Even Owen Jones welcomed Clegg’s commitment before arguing that as Deputy Prime Minister he has overseen cuts in mental health care of over 2% in real terms with cuts to mental health trusts being 20% more than those administered to other hospitals. Referrals to mental health departments have gone up by 16% yet there are 10% fewer beds for mental health patients. Jones argued that, “If we are to judge politicians by what they do rather than what they say… then Clegg has proved a terrible failure on mental health. In addition to pointing out that men should be allowed to cry and shouldn’t have to hide their sexuality, he proposes more spending on mental health care in keeping with it being the great unacknowledged illness of our time.

All this seems to have come about as a result of some stiff lobbying. The Chief Medical Officer, Dame Sally Davies reports that the number of working days lost to stress has risen by 24% since 2009 to around 70m. This costs the economy up to £100bn pa (which rather puts the government’s £120 million over two years into some context) yet 75% of people with mental illness get no treatment at all. She was supported by Professor Sir Simon Wessely, president of the Royal College of Psychiatrists and Professor Sheila Hollins, chair of the British Medical Association’s Board of Science who promised to, “Continue to call for equal treatment for both physical and mental health patients, the reduction of waiting times for mental health patients, and the introduction of equal funding between mental health services and other NHS services.”

It seems that everyone who has something to say on mental health is keen to remind us that it is the great unacknowledged illness of our time. Is it bollocks!! I’m not being disingenuous here. I have suffered from bouts of depression from the moment I was able to articulate it. From a young age I have been subjected to programmes of medication and therapy. None of them worked – but my bouts of depression are much more infrequent than they once were. Surely there must be some causal link? No. My last contact with NHS mental health treatments left me off work for months, feeling suicidal and unable to even leave the house to buy a newspaper. The doctor described my situation thus,

“Much as someone can get a broken leg, you have a broken mind. But it can be fixed. I’ll prescribe you some pills. You need to understand that this will be a long term treatment and once on this medication you cannot come off it without medical advice and support.”

“Can’t I just have some counselling or someone to talk to?” I asked.

“We don’t really do a lot of that on the NHS,” came the reply. “I could possibly arrange a session or two but you will really need to source that privately.”

So I went home with “a broken mind” and a prescription for a course of drugs that I could be on indefinitely. I left NHS care feeling I was on a downward spiral that would lock me into years and years of depression. No wonder I was fucking suicidal!

What helped me was the solidarity and support of my trade union. By happy coincidence I had a long-standing commitment to go on a residential reps course. I was in tears on the phone telling them that I couldn’t possibly come because I couldn’t leave the house. But the people there would have none of it and over several long telephone calls they convinced me that I would be amongst friends, that I could participate or opt out as I saw fit and there would be someone there to support me who would not judge or pressure me. I psyched myself up and went – and it was the best thing I did: better than any of their medication – or even the counselling that I had sourced privately and seemed pre-destined to blame my parents for everything (and in all honesty they never did much wrong). That union course was the start of my recovery. One that gathered momentum as I was elected to a branch officer’s role that enabled me to help my fellow workers who were going through similarly stressful situations at work or home.

And that’s the point! My depression and the depression of most of the people I have met has been in reaction to the stressful and alienating circumstances in which they find themselves. Obviously all people are different and some people might be more pre-disposed to depression (I myself have a history of depression running through both sides of my family) – but it is the circumstances of their lives that push them over the edge not the pre-existing condition. From my experience both as a patient and as someone who often found themselves called on to support people who are suffering, I firmly believe that most mental illness is caused by the society we live in – that is to say the atomised capitalist society of the late 20th / early 21st century. Medicalising it as some great plague is to totally miss the point but this is what happens. According to the Mental Health Foundation’s Fundamental Facts booklet, although mental health problems are defined and classified by medical professionals, mental health diagnoses are controversial, there is no sharp distinction between common and severe problems. Symptoms are divided between ‘neurotic’ (extreme forms of ‘normal’ emotional experiences such as depression, anxiety or panic) or ‘psychotic’ (which interfere with a person’s perception of reality and may include hallucinations, delusions or paranoia, with the person seeing, hearing, smelling, feeling or believing things that no one else does). Despite advice to the contrary people are often labelled and categorised by their symptoms rather than being treated as individuals.

We are not biologically pre-determined to go mad. We do not catch the great madness disease. And we don’t drive ourselves mad with drugs. We are driven to depression by the dehumanising society we live in – and that is not madness but a perfectly sane response to our circumstances. Look at the evidence. The World Health Organisation forecasts that by 2020 depression will be the second leading contributor to global illness. The NHS Confederation’s Mental Health Network reports that the proportion of the English population aged between 16 and 64 meeting the criteria for one common mental disorder increased from 15.5% in 1993 to 17.6% in 2007. The number of prescriptions written for anti-depressants has tripled since the early 1990s. In 2012/13, there were 50,408 detentions under the Mental Health Act, up 4% on the previous year. Household income correlates strongly with mental health problems. The lowest household income group were three times more likely to have a mental disorder than the highest income households. Suicide by mental health patients in England has risen to  1,333 deaths in 2011, “probably reflect(ing) the rise in suicide in the general population, which has been attributed to current economic difficulties.”

As we have seen, workplace stress is one of the biggest causes of absence in the UK. How can that be in a workplace so stuffed with labour-saving machines? Because the labour saved goes into more profits for the shareholder not ameliorating the condition of the workers – who just get more pressure to work faster and smarter and out-perform the computer or be thrown into poverty. Two thirds of people with mental problems think that long hours, unrealistic workloads and bad management caused or exacerbated their condition. Likewise, only 14% of people who felt they had complete control of their lives suffered mental problems, while the figure was 56% of those who had little control.

1 in 4 people using mental health services has no contact with their family, and 1 in 3 has no contact with friends. The Con-Dem period of austerity has seen mental illness rise as families are increasingly dispersed as they “get on their bikes and look for work” or as they are socially cleansed from London and other supposedly desirable locations. But this is just the latest and most obvious manifestation of a problem that has been going on way longer than that. The local community has been destroyed by the rise of the superstore and shopping centre. Those with nothing are under constant pressure to get more, those with something are under pressure not to lose it and even those at the top are under pressure to, like the sharks they are, keep moving forward. They talk of continuous improvement and berate those below them if it is not achieved. Who berate those below them, who berate those below them.

Under this pressure relationships flounder. Those with mental problems are twice as likely to be separated or divorced. Without the support of family and community they wither and die. Social isolation is a factor in mental health problems. 20% of people with common mental health problems live alone, compared with 16% of the overall population. In the absence of true community people seek solace in the false community of nationhood and religion – both of which create false divisions to mask the true divisions of capitalism. If you suffer from depression in such a society you are not mad. You are sane – probably more sane than those who don’t.

There is clear evidence that mental health issues are on the rise. There is also ample evidence that they are tied to other indicators of disadvantage such as class and race. People with mental problems are more likely to live in urban areas. Those from the most deprived and remote areas have the highest levels of mental problems and suicide. Other social and economic risk factors include: poor transport, neighbourhood disorganisation and racial discrimination. A study of British adults found that the psychiatric problems increased as household income decreased with the poorest fifth of adults having double the risk of mental health problems as those on average incomes. Children in poor households are three times as likely to have mental health problems as children in well-off households. Ethnic minority groups are 60% more likely to suffer from depression, twice as likely to have a psychotic disorder, three times as likely to be admitted to hospital and 44% more likely to be detained under the Mental Health Act.

This is even the case for psychotic illness, they are almost three times as likely to be living alone, five times as likely to report a lack of social support and more than fifteen times as likely to have experienced sexual abuse. With such strong links to indicators of disadvantage we either have to accept the widely disproved science of eugenics, that the poor and ethnic minorities are biologically pre-disposed to mental illness, or we have to accept the rather more likely explanation that mental illness, much like physical ill health and educational disadvantage, is caused by poverty. In which case, Cameron and Clegg’s promises and the calls to invest in addressing the great unacknowledged illness of our time are fundamentally flawed and amount to little more than blaming the victim and medicalising their perfectly sane and human response to an insane and inhuman society. Conversely factors such as community empowerment and integration, provision of social services, tolerance, and strong community networks are proven to have a positive correlation with good mental health. Furthermore, the stigmatising among the wider population that people keep talking about appears to be overstated. A survey of people with mental problems found that 67% had admitted it to close colleagues and 61% had told their manager. 1 in 10 had told everyone and only about 1 in 10 of those said colleagues made negative comments.

In Germany in the 1970’s the SPK (Socialist Patients Collective) identified illness as being rooted in the capitalist system. Dr Wolfgang Huber of Heidelberg University believed that his patients’ mental disorders were caused by the capitalist system, and that these disorders could only be cured by a revolutionary change in society. Using such slogans as, The system as made us sick. Let us strike the death blow to the sick system,” the SPK promoted illness as a protest against capitalism and opposing medical doctors as the ruling class of capitalism. I remain unconvinced by the extremes of their position but the argument that a professionalised medical system, embedded in capitalist culture, has served to medicalise and stigmatise the human screams of pain from within a corrupt and corrupting system, does appear to have some validity. As the medical profession medicalises so the medical industry medicates. Making good money selling chemical coshes, blaming their families and locking them up when that doesn’t work – just as in the old days of Bedlam – and all at a price to make the shareholders happy.

That is the future the Con-Dems (and even more so UKIP) would have for us. The left would just throw a little bit more money at it while doing little if anything to address the root causes. So let us not fall for this “great unacknowledged illness of our time” hype. Let us not condemn and stigmatise our brothers and sisters – and ourselves. Let us instead offer solidarity, friendship and hope; hope of a better society; hope of a society built on solidarity and mutual aid not individual greed and the law of the jungle. This won’t be achieved through the capitalist system. It won’t be achieved by state capitalist tinkering. It will only be achieved by a fundamental and revolutionary change in the way that we live.

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Posted in Health, Inequality, Knowledge, Politics, Power

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