DABHD debate – mental health: where do we draw the line?

Something has become clear from the feedback I have had on DABHD so far – it is being seen as a fascinating and useful illustration of how depression, anxiety and other mental health difficulties can affect people in different ways and respond differently to various treatments.

So, can we start a debate? A non-judgemental debate that offers an opportunity to express views and opinions freely on a subject that affects the lives of around 25% of the population? Shall we call it ‘Emotional pain and medicalisation: where do we draw the line?’ and see where it takes us…..

No one person experiences emotional pain in the same way, so how can we expect a ‘one treatment fits all’ solution to make a real impact? At the moment the NHS promotes therapies based heavily on cognitive behavioural therapy or CBT. This approach doesn’t work for everyone, and if it does work, it’s effect can be short-lived. I undertook a course of CBT which helped for a few months but which has now left me with a legacy of guilt – I know what I should be doing to address my anxieties but I cannot put the theory into practice anymore. Am I a failure? Or is CBT too simple an approach to a complex subject?

In the media, celebrities are raising awareness of mental health problems with a focus on reducing the stigma often attached to an admission of mental ill-health. The favoured way to do this, it seems, is to compare mental health directly with physical health  – there is no stigma attached to the pain of a broken leg, so why should there be any attached to emotional pain? But does this approach help long-term? Is there a danger of a backlash against what has already been perceived in some circles as a ‘fashion’ for fragility in the celebrity community? There is a great article in the latest edition of One in Four magazine on this subject. I recommend a read.

The celebrity approach also focuses heavily on the  taking of anti-depressants to alleviate symptoms. But does some medication just mask the problem? If you go through therapy whilst on medication, can you ever get to the root of your emotional pain? Or is it impossible to deal with that pain, without at least something to support you through it? Who can have a tooth out without local anaesthetic? Is that a safe analogy? It would be interesting to hear from psychotherapists on that point.

Perhaps a key question here is ‘are mental health issues sometimes an illness and sometimes not?’. When does normal emotional pain become an illness, if it ever truly does?

I think that until we address these issues there will always be those who see mental ill health as a weakness; a lack of balance that makes a person an unreliable employee, friend or partner. The NHS will continue to adopt the approach that appears to offer the quickest results at the cheapest price, without considering what an individual actually needs.

We need to reduce the stigma surrounding mental health issues. I believe a book like DABHD can help inform the debate. So what do you think?


15 thoughts on “DABHD debate – mental health: where do we draw the line?

  1. Excellent post and some very thought provoking points. I do very firmly believe that talking honestly and openly about MH issues is a healthy step forward and the book DABHD will be a good addition to the arena. thank you.

    • Thanks Viv. I do think that there are opposing views out there that never seem to mingle much in the media. The fact that Ruby Wax, who has done such a lot to get the media to tak the subject seriously,
      can describe herself as ‘the poster girl’ for mental health suggests (rightly or wrongly) that hers is the prevailing view.

  2. The work of Paul Gilbert and his Compassion Focused Therapy has something useful to say here. He points out that our awareness of threat system was developed during our evolution. To keep us safe it over-rides the other systems. It needed to. Our teeth and claws don’t really compete with those of baboons or lions.
    As our brains developed we got very imaginative but this ability can be high jacked by the threat system so we make it worse. He teaches that this is not our fault but a consequence of the way the brain works.
    We know that loving parenting creates a secure base inside us (heard it today on Woman’s Hour as i was driving). If a person doesn’t grow with that can we hold them responsible? As we get older we have to take more responsibility for who we are.
    Gilbert says we have a soothing system (the parasympathetic nervous system for the swots) and we can train it. It is essential to express compassion to one’s self.
    Jesus said there were two main commandments; one to love God and the other to love others As ourselves. As a counsellor I meet a lot of people who seem to love others more than themselves. Not many who love others less than themselves. Funny that! We have to give support to ourselves as we do others. One reinforces the other.
    This brings me to my last point. Living in a toxic environment makes it more likely we will be infected-as slumdwellers often died of diseases. In the last thirty years the economic structure has been shaped by the so-called Washington Consensus which believes in privatisation, downsizing for ‘efficiency’, targets (and if they are met, they are often raised) and constant hyped language, Not just in private industry. In schools it sounds like ‘constantly driving up standards’ (as though they can continue to improve without limit) but one finds the same things in medicine and other governments, I have seen a number of employees of a local government and there seems a constant possibility of having to re-apply for their jobs. Possibly it is believed that it keeps people incentivised. In fact it generates anxiety and frustration.
    Add to this the fragmenting of local societies and constant propaganda that happiness is gained by ‘having things’. Eric Fromm wrote of the choice between “to have or to be”. We have often lost sight of the need to nurture ourselves, families and the community in which we live.There is a social dimension to mental illness and to pin the responsibility on individual weakness is to ignore dimensions of reality.
    Congratulations on your book Suzie. I hope others respond.

    • Thanks for leaving such a detailed response Ian. I am currently struggling with that tough ‘to have or to be’ question. When it isn’t just ones own self in the discussion it makes things very hard to unravel.

      • You are right, Suzie, in that when others are involved, we can find ourselves working in one area when we would rather be in another, because it earns more money and is necessary. I’ve been there. However, we can still have a bit inside us which can ‘be’ . In other words we can cultivate ourselves to a degree even if we are involved in competitive and grasping environments. Not easy I acknowledge but not doing it leads further down the dark path.
        In my view It’s not a choice between struggling and not struggling. There will always be a struggle,(At this point Buddhists pop up and shout ‘Dukka’-the first of the Four Noble Truths) the issue is the nature of our struggle. For some it’s how to be more important or richer or fulfill 50 types of fantasy, for others it is how we walk the path of life. And, you know, we already do much of it in our lives but we often don’t give ourselves credit for it.

  3. First, and crucially, you are not a failure! You have a perfect right to your feelings, whatever they may be and wherever they have their roots. However, you may wish to live in a more comfortable way…
    I have worked with more than one CBT “graduate” who has found it to be just one more stick to beat themselves with and my perception is that it is a process that tends to substitute one fixed belief (the “bad” one) with another (the therapist’s chosen “good” one). And when that process isn’t terribly successful, the client feels the “failure” keenly.
    NLP has been really helpful in these cases. The key concept of flexibility bypasses the substitution of one fixed belief with another, and another key concept of NLP – that there is no failure, only feedback – can take care of the awfulness of the feelings when it doesn’t appear to work.
    So important, too, to love all the bits of yourself. Especially the difficult, painful bits.

    • Thank you! It is good to hear a view from the other side of CBT, recognising that additional stick I now regularly crack myself over the rear end with! I had thought it was a matter of ‘practice’ and maybe I hadn’t tried hard enough. Now I tend to think that as you say, there are different routes to getting to the heart of certain feelings for different people.

  4. Our road to healing has to go through our suffering and not round it. We need to hang about in some dark places. This is not easy, but we can ‘realise our soul’s potential’ if we have the courage to do this. Hopefully in depth psychotherapy we find a therapist who can accompany us on this journey, not telling us what we should be thinking or feeling, but reflecting us back to ourselves so we see a little more clearly, and, above all, so we know that someone else ‘gets it’.

    • I love the idea of being with someone else on the journey. I have recently felt that my own therapist ‘gets it’ which is helpful. Though that part of me that also gets guilt feels pretty worried for the chap….It must be tough to take those journeys on.

  5. In the depths of despair a client needs to be made to feel safe, needs to learn to trust and needs to feel validated. If healing is to happen the client needs to learn to understand herself, forgive herself and to love herself. This change needs to happen from working at relational depth, at the client’s chosen pace. The client needs be accompanied, on what can sometimes be a very scary journey. Accompanied by a therapist who contains the process. From that place deep within the individual, comes the positivity and energy of healing,the flow of greater self acceptance,of greater clarity and renewed empowerment. The power to move on in life.

    CBT alone is not always sufficient and does not suit all client types.

  6. The subject matter goes to the very heart of the problems we are experiencing in our society, linking the banking crisis, conflicts throughout the world and dare I say it the ephemeral OTT euphoria of the Olympics.(Which I did enjoy). One cap does not fit all, a therapist can only provide ‘sign posts’ on the road to recovery but because we are unique individuals, the signs have to be provided in many different languages. Big Pharma is a significant player in medicalising any symptoms but unfortunately they do not operate with a totally alltruistic intent or moral standing.
    ‘The physician’s highest and only calling is to make the sick healthy, to cure, as it is called’. Samuel Hahnemann, The Organon, 1742. Have we not learnt anything since then ???

    Andrew Wilcox

  7. Interesting that Andrew, above, mentions Samuel Hahnemann, generally acknowledged to be the father of homeopathy. This is an alternative route to health and well-being mostly dismissed by the medical profession who are afraid to think outside the box of their training and who are in the pay of drug companies. Can there be any doubt that modern drugs create as many problems as they solve? Why are they dispensed in such heavy-handed quantities and potencies? Nowhere is the situation more delicate and sensitive than in the area of mental health.

    I’m only a lay person, but have studied and have reasonable experience of homeopathy over thirty years. It’s a scientific discipline whose practitioners have instinctive insight. It’s a deep and complex subject but, looked into, makes enormous sense.To be a *fully qualified registered practitioner*, it’s necessary to be a fully qualified doctor first, so we’re not talking about health shop dispensaries here, helpful though they can be at times.

    How does this relate to mental health? Well, to begin with the approach and assumptions are quite different from the orthodox. There are no implicit judgemental attitudes, or ‘oughts’ and suggestions of what’s irrational. The practitioner will match remedy profiles with the reality of the patient’s experience. The ‘symptoms’ are often not those a Health Service doctor would take into consideration and might even regard as bizarre.

    What our culture fails to take into account is that we are biochemistry. Any imbalance, however caused, can lead to real illness, including mental illness (perhaps especially mental illness!) but in many cases relief can be achieved over a period of time with qualified help which addresses the whole person (wholesale sanity). The efficiency of homeopathic remedies is derived from the method of potentisation rather than merely their source.

    It is worth remembering that although we owe Edward Jenner a huge debt for our health-promoting vaccination programmes, his thinking was influenced by the discoveries of physicians like Hahnemann. The ‘like cures like’ principle is well demonstrated in this field.

    It seems homeopathy is seldom available on the NHS, but as there are no drug companies to fund, costs lie in consultation which, as far as I understand, is not excessive.

    These are just a few thoughts, based on personal conviction. I believe it’s worth serious investigation. Once the basic principles are grasped, it leads into a whole new way of looking at creation and how we function within it.

  8. I participated in a CBT program a few years ago and really feel I got little if anything. I didn’t even get Suzies couple of months out of it, I just never got it going. At least I never had the, errrr, opportunity to turn it into another whip for myself.

    I am definitely NOT a fan of CBT, at least in the form as I’ve come to know it. It seems to be getting recommended for a wide range of illnesses, both physical & mental (emotional?). My current partner was recently diagnosed as suffering Myalgic Encephalomyelitis or perhaps Multiple Sclerosis, 2 very closely related diseases. Neither of us can believe the recommendation of CBT to help deal with the pain! Good if you can do it I suppose.

    As for the issue of to medicate or not, I believe each individual is different and has their own needs. One major issue I see with mental illness is misdiagnosis & a lot of ‘trial & error’ to find out firstly what the real problem is & then to find a solution that works – weather medication, therapy or a combination of both.

    It took me almost 11 years to get to my current diagnosis and for me that time was a journey through hell. Since then I’ve come to realize there is no way I could function anywhere near ‘normal’ without the medications I take. I spent too long in a hole while things weren’t right to ever think of relying solely on any form of therapy, no matter how well meaning it may be.

    Medical services around the world need to learn that everyone is different & trying to pigeonhole people based on a broad classification process cannot, will not, work. It is likely to lead to many more problems (& greater expenses) than it solves (saves).

    Just remember, You are an individual, just like everyone else….. 😉

  9. Pingback: Update on DABHD debate: Charity Mind work with The Times on mental health & medication « Dandelions and Bad Hair Days…

  10. Pingback: On laying ghosts and raising dandelions | Mental Health Talk

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