Saturday 20 September 2014

The Stairway To Heaven, Oh It Starts In Hell

Hello readers, and welcome to the latest instalment of On My Cloud, where I like to ramble on about things I feel strongly about!  I say ramble partly in jest, as I hope that in reality the things I say are considered valuable by others too and strike a chord with at least some readers.  The reason I write this blog at all is that I feel the things I’m writing about are incredibly important and need to be in public awareness, so as always I welcome and encourage comments and sharing with others who may be interested in what I have to say. (Thanks!)




Having experienced a few dry spells with my writing, at the moment I’m a bit inundated with ideas for things to write about, largely due to my current reading around psychiatry and mental health services.  Most notably, I am presently reading a book entitled Cracked: Why Psychiatry is Doing More Harm than Good by James Davies (a fantastic read that I’d recommend to everyone, although it makes my blood boil!).  I don’t need to explain what it’s all about, since the title does a good enough job of giving you the gist. 


 

I was prompted to write this post when reading a chapter that addresses cultural interpretations of emotional suffering and mental distress, just one issue amongst the many revealed by Davies in the book.  This particular topic, though, somehow struck a chord with me in a way that inspired me to write about it first above everything else, perhaps because of the personal significance it has for me as well as the wider social and cultural questions it raises.  As a result, what I think we’re going to end up with is a piece that not only addresses one of the widest and deepest cultural issues I’ve written about yet, but also one that is more personal and self-disclosing than anything I have written previously.  I hope it makes for a good read!




(Having already taken three paragraphs to introduce the topic!) I’d like to start by posing some questions: what does emotional suffering or mental distress mean to you?  What function do you believe it plays, if any?  Or is it just something that gets in the way and needs to be gotten rid of as promptly as possible?  In Cracked…, Davies notes that in Western culture, mental suffering has come to be perceived more and more as something that does not serve a purpose or function, and needs to be removed by any means possible.  Psychiatry has purportedly contributed significantly to this perception, as I will explain briefly now.




To give some context, one of the key objectives of Cracked is to expose the arbitrary and corrupted nature by which mental illness is defined by psychiatry, and the building of a mythical world in which mental distress is caused by some physical or biological phenomenon.  In fact, what you’ll find if you dig deep is that there is actually no scientific backing for this notion.  However, as psychiatry has gained power (largely though the financial rewards associated with pharmaceutical industry links), the notion that mental distress is biologically rooted has taken hold in our culture, therefore rendering mental suffering as a result of abnormality, to be eradicated by psychiatric interventions (which sadly almost inevitably means medication). 




Mental distress: part of being human or bioliogical abnormailty?!
Eradicating suffering and emotional distress sounds great on the surface, so one might argue that it’s wonderful that psychiatry offers a solution to this.  Aside from the fact that there is little-to-no scientific backing for this approach (to be discussed further in later posts!), there is another problem here.  Before we started to view mental distress as a sign of illness and abnormality, we relied much more heavily on psychological and spiritual explanations and ways of coping.  Addressing distress in this way, I believe, is far more productive.  By recognising the causes of distress, often traumatic events or general life stressors, we can also properly deal with the problem rather than blunting it.  Furthermore, we can learn and develop from the experience.  As the aforementioned Mr Davies notes, “from affliction there can be derived some unexpected gain, new perspective or beneficial alteration”.   




The above statement rings true and resonates with me, and I feel uncomfortable with the fact that more and more suffering is being medicalised and passed off as something to be blunted and controlled.  More and more things that were once accepted as a normal part of the human experience are now defined as symptoms of mental illness.  I feel that resilience is one of the most important things in the maintenance of psychological wellbeing, and the medicalisation of distress is not helping us to build a resilient and mentally healthy population.




As already hinted at, I am of the school of thought that distress can be learned from and help a person to develop and overcome life’s challenges, and that this is being stifled unnecessarily and unhelpfully in many cases by the current misguided tendency, through psychiatry, to associate mental distress with biology.  (To illustrate my point: how many times have you heard the phrase ‘chemical imbalance’ in relation to mental health?  If you were to read Cracked, you’d realise this is an unproven and therefore dangerous notion, which is why I am so concerned by the view of suffering that psychiatry instils). 




I’ll illustrate my own personal stance on this topic using a combination of anecdote and music.  As regular readers will already know, I am a huge music fan and like to give each blog post a lyrical title and refer to relevant music within my writing!




To quote a cliché and indeed song title, “what doesn’t kill you makes you stronger”.  And let’s be honest, clichés generally materialise because there is an element of truth in them to begin with.  Most of us have probably had times when we could really relate to this statement, times when we’ve come through adversity feeling stronger than before.  For me, the best example is a relationship break-up I went through a few years ago.  It felt like the worst thing ever at the time, like the pain would be endless and insurmountable.  Of course, this wasn’t the case!  As beautifully articulated by Matt Cardle in his song Porcelain:




All the things in this life that you thought you just couldn’t bear

It’s the pressure inside makes the diamond that’s shining there

All the pain and the heartache can break you and shape you like clay

Now you’ve come through the fire and that makes you porcelain




It took a long time, but once I’d got over it I felt so much better than I had whilst in the relationship.  Not only this, but I realised that I’d learnt a lot and gained new perspective on certain things.  For me, the gaining of perspective is perhaps the most important benefit of coming through adversity and dealing with distress in a productive way. 




Many people who have experienced bereavement will be able to relate to the idea that such events, whilst horrendous, really have the power to make us appreciate life, the world and, most importantly, the people around us, more than we did before.  I myself experienced a significant bereavement during my teenage years: I am one of triplets, and unfortunately one of my two brothers took his own life when we were just 14.  Of course, this is a horrible thing for my family to go through, but it has undoubtedly altered my perspective on life and made me so much more grateful for my loved ones.  Indeed it has probably also, on some subconscious level, influenced my aspirations in life and driven some of my passion for the very things I write about now.




Of course there are negatives as well: for instance, the incredibly sudden and unexpected nature of the incident meant that for a while I experienced high anxiety around thoughts of similar things happening again, and still do to a certain extent.  However, I can now recognise this as a fairly normal, if slightly irrational, reaction to a traumatic experience.  If I were to read the DSM (or Diagnostic and Statistical Manual of Mental Disorders, which lists
all the conditions psychiatry has decided constitutes a mental disorder), I would probably find that I could diagnose myself with several ‘disorders’ based on this and other features of my personality, experiences and feelings.  Since I have worked through these difficulties and gained something from this, I hope you’ll agree that receiving a diagnosis of a mental disorder would not have been helpful to me, but this is what’s happening to people every day when they end up in mental health services.




What worries me is that more and more normal human experiences are being medicalised by psychiatrists.  This is characterised by the fact that each time the DSM is revised, the number of disorders it lists grows.  This is surely serving to reduce our ability to view distress as a normal part of human experience and enhancing our propensity to view it as a sign of illness that must be treated.  I find this thought quite scary, particularly considering that the diagnostic criteria set out in the DSM are based on nothing more scientific than the perceptions and discussions of a bunch of guys who work for the APA (American Psychiatric Association).  Anyway, I think I’m going off on a bit of a tangent here, so I’ll leave it there for you to ponder if you wish, with the promise of more on this in a later post.




I remember hearing a psychologist called Rachel Perkins speaking at a mental health conference last year.  There is one thing that she said that I remember very well because it resonated with me at the time, and I’m glad I remembered it because it is even more poignant for me now!  She noted that culturally we have come to rely on ‘experts’ (ie healthcare professionals, psychiatrists, etc.) to deal with our distress for us.  Why has this happened?  Shouldn’t we all in fact be the experts in managing our own distress and helping those around us to do the same?  I would agree with Ms Perkins that the answer is yes, we should be turning more often to ourselves and our support networks and less often to medicine to deal with normal human suffering. 




I myself am a big advocate of using support networks to overcome challenging times.  Yes, I’m incredibly fortunate to be blessed with a wonderful family and great friends, where others aren’t so lucky.  But that’s what support groups and such like are for, and all the more reason to invest more money in community-based, non-medical approaches to wellbeing, over medication and hospitalisation.  It’s amazing how beneficial a good chinwag can be, whether this be with a friend, family member, counsellor, support group, teacher,
Coffee and a chat: Something I find very therapeutic!
hairdresser, or a stranger you met on the bus! 




To me, it makes so much more sense to take this positive view of emotional suffering, to work through it and gain something from it, rather than demonising and abnormalising it (abnormalising isn’t actually a word but I’m using it anyway as it sounds good in this context!).  I’m not suggesting this is true for all cases of suffering because of course there are times when people are so severely distressed that a more intensive form of intervention is needed.  My point is that as psychiatry and the social constructs of mental illness grow, so does the perception of distress as abnormal, which I suggest is not a healthy feature of modern society. 




To lighten things up a bit, I’ll give you a few more anecdotes about my own ways of dealing with distress.  In previous posts I’ve talked about lifestyle elements and their impact on wellbeing, but I also use simple thinking processes to work through emotional difficulties. 




Something I actually find very helpful is, when I’m feeling really low or anxious, to consciously tell myself that this is a normal part of the human experience, or an understandable reaction to whatever is going on in my life at the time.  I find that this helps to ground me and perhaps to start problem solving whatever the problem is, which in turn helps me to steer clear of turning to ‘professionals’ for support that I don’t actually need.  I think there’s also something to be said for taking some of that distress and turning it into something positive, for example, channelling anger or hurt over an unfortunate experience into working harder to achieve my goals.  Another thing I find useful is to remember that without the bad times there wouldn’t really be good times either: in the words of Thomas Hardy, “If a way to the better there be, it first exacts a full look at the worst”; or, as Matt Cardle puts it, “The stairway to heaven, oh it starts in hell”.




If the above and other coping strategies don’t quite work as well as I need them to, then I know there are options available for further support, and have indeed made use of input from counsellors and psychologists in the past (I’m not completely adverse to the use of services and hope it doesn’t appear that way from what I’ve said here.  If it does, then be assured that this is only because I feel so passionately that the alternatives need greater attention!)




There is a fine balance to be struck between developing the right services, education and awareness (along with stigma reduction) so that people can access the support they need when they need it, and not becoming overly reliant on such support, which culturally we are in danger of doing.  Unfortunately there is a lot of work still to be done on all these fronts, and getting each one of those things to the level they need to be at is a very tall order (and once which I hope I can make a worthwhile contribution to fulfilling!).




To summarise, there are two main ways of perceiving mental distress and emotional suffering:  the positive view that it is a natural part of the human experience that can ultimately be gained from, and the negative view that it is the result of some kind of abnormality of the brain or biology.  There is some place for both, but as psychiatry has grown the negative view has seeped stealthily into our culture, leaving less and less room for the positive one.  I myself am an advocate of favouring the positive view a little more, and I’ll finish by leaving you with a couple of songs that depict my stance on the topic quite nicely.  Thanks for reading!







Friday 5 September 2014

Freedom


elementalwellbeing.org

I have recently been fortunate enough to come into contact with a lovely lady by the name Marion Aslan, who runs the charity Elemental Wellbeing.  Elemental Wellbeing provides non-medical approaches to mental wellbeing, with a particular focus on the THRIVE approach and emancipation from diagnoses of mental illness.  Marion recently asked me to write a few lines on emancipation; I got a bit carried away and the result is this piece!

To me, the importance of emancipation from a diagnosis of a mental health conditions is obvious.  I say this not just because I feel strongly that this is the case, but also because research evidence firmly supports the statement.  Worryingly, said evidence is not even a new phenomenon; huge problems with mental health diagnoses were unearthed back in the 1970s, when Rosenhan and colleagues conducted a brave and fascinating experiment to see how easy it would be to get themselves admitted to psychiatric hospitals. 

Having reported no other symptoms than hearing a voice saying the word ‘thud’, all eight participants in the aforementioned experiment were admitted to their respective hospitals for anywhere between several weeks and several months, despite acting perfectly normally and feeling quite well.  What got them out was not convincing staff that they were not unwell, but agreeing that they were and feigning getting better. 

It doesn’t end there!  When Rosenhan came into contact with one of the hospitals after the episode outlined above, he was challenged to send more people there to try and get admitted.  This challenge was accompanied by a promise that they would be spotted this time.  The hospital later contacted him to boast that they had uncovered 41 ‘fakes’.  How many people had Mr Rosenhan actually sent, I hear you ask? None.

For me, the Rosenhan experiment is one of the most poignant I’ve ever read about, and the perfect illustration of the dangerously ambiguous nature of mental health diagnosis.  But there are other factors that support my argument too: Results from similar studies supports the above findings, plus there is other research to show that in a great many cases, one psychiatrist will give a different diagnosis to the same patient as another psychiatrist.  We should also give consideration to the fact that our diagnostic criteria for ‘mental illnesses’ are based on nothing more scientific than a bunch of guys at the APA (American Psychiatric Association) sitting in a conference room and pondering what name to give to each collection of symptoms that psychiatry deems as constituting a mental illness.

Collectively, the above points serve to illustrate the very arbitrary nature of the diagnosis of mental health conditions.  To me, this is slightly sickening and made worse by the fact that once a person has been labelled with a mental health diagnosis, psychiatry holds them to have a lifelong illness, and it is near impossible to shake off that label.  The reason I find this so disgusting is that psychiatry will then proceed to deem every single thing that person does as a feature of their illness, which is incredibly unhelpful in the process of enabling that person to recover and achieve a high level of functioning beyond their diagnosis.

To illustrate my point in more detail, I’m fairly confident that elements of my own experience and behaviour could, on occasions, be interpreted as signs of ‘mental illness’; something like bipolar disorder.  If I challenged you to spend a month or two interpreting my behaviour as though I were a psychiatric patient with this diagnosis, I reckon I would probably appear as ‘mad’ as anyone else with that label!  What’s happening is that a medical label is being placed on normal human experience, which I maintain is a dangerous practice.

To me it is incredibly unfair that people should be subjected to this kind of preconception just because they have had periods of difficulty and distress, and it would be far more productive to recognise such periods as transient experiences that can be fully recovered and moved on from completely. 

Many of my colleagues who work in the field of mental health will argue that there are some patients who will never recover, will always need medication and will always be susceptible to further episodes of difficulty, or ‘illness’.  My own stance is that each person is different, and to be honest I am currently unsure whether I believe this is ever the case or not.  However, to me, even if there are some people who will suffer multiple periods of distress throughout their lives, surely it is far more helpful to those people to allow them space to be free from diagnosis and to live accomplished and meaningful lives?  I feel that the concept of mental illness is an unhelpful and quite inhumane one, and much prefer to treat people as people rather than illnesses, move away from the assumption that they will be forever subject to their psychiatric label, and ultimately empower people (or rather allow them to empower themselves) to recover and thrive.