The politics of mental health

A report has just been published by the Centre for Economic Performance at the LSE which is a fairly damning indictment of the way the NHS deals with mental ill health compared to physical health problems.1  The report highlights the fact that although mental illness is generally more debilitating than most chronic physical conditions, only a quarter of those suffering from mental health problems are in treatment, compared with the vast majority of those with physical conditions. 

The report recommends, amongst other things: an expansion of the IAPT (Improving Access to Psychological Therapies) programme; better mental health training for GPs, who are still the main ‘gatekeepers’ to mental health services; and more psychiatrists.  It also strongly criticises the NHS and the government for cutting back on existing IAPT services and for making no concrete commitments to its future.  The report ends with a plea to NHS commissioners to rethink their priorities. 

The point is, though, there is nothing new here.  The whole point of the IAPT programme (which, incidentally, was championed by the same Lord Layard who is also one of the authors of this current report) was to enable more people to access talking treatments on the NHS.  And yet so far, referral rates to IAPT have been pretty dismal, something in the region of 12% of the potential demand. 

Of course, the report is right to highlight issues around GPs’ (lack of) awareness of mental health problems, and the fact that psychiatry is still regarded by many in the medical profession as a ‘Cinderella service’.  But this all begs the question as to why this should be so in the first place. 

There are no lack of answers to this question, and one of them revolves around the issue of stigma.  For many people in this country, admitting to having a mental health problem is the one thing they will not do.  In other postings and in an article in Therapy Today I have highlighted how this is especially a problem in the financial world2.  However, it seems that this is a much wider problem.  Recently an MP ‘came out’, so to speak, regarding his OCD – and did so in the chamber of the House of Commons.3  The major mental health charities have ongoing campaigns to combat stigma and discrimination regarding mental illness. 

But what is it about mental illness that is so stigmatising?  One way to address this question is to look at the effect that, for example, depression or anxiety has on an individual’s life.  Often it means they can no longer ‘function’ properly at work, in their relationships, in their leisure time.  In other words, they can no longer live the life that they used to live or, perhaps more critically, the life they think they are supposed to be living, the life that other people think they should be living. 

Of course, it’s all too easy to romanticise mental illness, to argue that it is an alternative lifestyle, which is what some in the anti-psychiatry movement were arguing in the 1960s and ‘70s.  Not that there is anything inherently wrong in this argument: after all, who ultimately decides what a ‘normal’ lifestyle is?   The neuro-biologists might argue that it’s all a matter of brain chemistry, but who is to decide what’s ‘normal’ brain chemistry and what is ‘abnormal’?   One argument might be to look at the statistical norm: but this would entail conducting a mass study of the neuro-chemistry of the population, which is extremely unlikely to happen – at least not yet.    And even if such a study was to be undertaken, what would this tell us?  That most people’s brain are in a particular neuro-biological state?   What this wouldn’t tell us, of course, is the extent to which neuro-chemistry is influenced by environmental factors, and there is growing evidence to show that this is precisely the case. 

The reality is, of course, that it has very little to do with such arguments.  It’s whether or not people conform to a certain set of social expectations, and these expectations have nothing to do with biology.  People who are mentally ill have ‘problems’ with dealing with such expectations: they either can’t or won’t go along with what is expected of them.  This lack of conformity can make life very difficult – both for the individual directly affected and those around him or her. 

I think it is also fair to argue that mentally ill people are, in some way, a symptom of our world, a reminder of what’s wrong with our society.  In fact, they are a living embodiment of the failure of the dominant ideology, the dominant social fantasy.  In the City, for example, mental health problems, even ‘common’ ones such as anxiety and depression, are a living indictment of the ‘macho’, ‘dog-eat-dog’ culture, which cares little for real human beings, is only concerned with abstractions, which reduces everything to numbers on a spreadsheet.  In this kind of culture, to be mentally ill is, in effect, to call this whole ideology into question, to no longer be prepared to ‘play the game’. 

And this applies equally as well in other areas of social life.  Mental illness is, ultimately, a threat to the social fabric, the underlying values and fantasises that keep society together.  The strange thing is, of course, you would think that this would make the government and NHS take mental illness more seriously…………


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