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Posts Tagged ‘mental health’

At the end of October  published an excellent article in the Guardian which further reinforces the scepticism about psychiatric diagnosis that I have explored earlier on this blog. She succinctly makes what is a key point for me:

. . . the DSM [Diagnostic and Statistical Manual] only focuses on . . . “symptoms” and does not take into account the individual’s context. This in itself is a value judgment.

Below is a short extract. For the full post see link.

Psychiatric diagnosis must serve an ethical purpose: relieving certain forms of suffering and disease. Science alone can’t do that.

How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological?

This is essentially what a select group of psychiatrists decide each time they revise the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered a “bible” for mental health professionals worldwide.

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders. It’s now used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers, to name a few.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change. Over the years many of these amendments have courted controversy.

These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness.

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A DWP disability assessment questionnaire. Photograph: Alamy

In yesterday’s Guardian there was yet more evidence of the distressing and shameful  failure of our benefits system to understand the very real needs of those coping with mental health problems. Adam Jacques, the disabled husband of a claimant, writes movingly of his experience of his wife’s acute distress at being refused access to the personal independence payment system:

There’s nothing quite like witnessing your wife tumble through a gaping chasm, to see that there’s something rotten at the heart of a welfare assessment system. From what we experienced, the wrong people are doing the wrong assessments with the wrong tools, using incorrect assumptions. And it left me reeling: how could this happen to my wife? I discovered that her experience is just the calamitous tip of a PIP-denying iceberg.

Below is a short extract: for the full post see link.

My wife tried to kill herself in March. She took an overdose – while I was watching TV in the next room. Cue, in short succession: 30 minutes of heart-stopping panic, a nerve-jangling ambulance trip to A&E, an admission to a secure mental health unit, and a longer stay recovering in a crisis house.

Acute episodes such as this can be a recurring reality for someone with a longstanding mental health condition. From her battles with depression and struggles to get out of bed in the mornings, to anxiety so overpowering that a trip on a bus triggers a blind panic, for my wife (let’s call her Bea) life is a titanic battle to stay afloat. She experiences overwhelming feelings of worthlessness, guilt and impulsive urges to self-harm that can flood her mind and distort her thinking. Socialising with friends is hard, while work in the past year has been out of the question. But she’s also incredibly smart, funny, kind and brave.

Mental health is complex, but something simple triggered Bea’s overdose: a devastating letter from a “decision-maker” at the Department for Work and Pensions (DWP), informing her that her claim for personal independence payment, a disability benefit, had been unsuccessful. She’s not the first, and won’t be the last, to experience the dismissive treatment that people with severe mental health conditions can undergo when accessing the benefits system. And PIP, as the benefit is called, is one of the worst offenders.

PIP is supposed to offset some of the extra costs of a disability. Applicants are evaluated by health workers from the private firms Atos or Capita, who forward their assessments to a DWP decision-maker – who scores you on “daily living” and “mobility” (you need at least eight points for each to qualify). Currently nearly 3 million people claim some element of PIP, and my wife expected to be one of them. As did her benefits adviser, an NHS psychiatrist and a psychologist. So, armed with a dossier of supporting medical documentation, Bea applied. That was last November. I’ve seen glaciers move faster. . .

I discovered that her experience is just the calamitous tip of a PIP-denying iceberg. While the DWP claims it doesn’t operate quotas to save money, figures released in April, covering just six months of 2016, showed an enormous expansion in claimants receiving zero points, up to 83,000. That’s only 10,000 fewer than in the previous 12 months.

This raises huge concerns about the assessment process – especially given that, when rejected by the DWP, 65% of applicants who appeal to a tribunal get the ruling reversed. A panel of welfare experts told the work and pensions select committee earlier this year that the whole process was “inherently flawed”, with medical evidence often ignored by officials during the initial assessment.

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Kloey Clarke at home in Devizes, with her son Seth. Photograph: Adrian Sherratt for the Guardian

This week more disturbing news has broken concerning the way our society treats mental health problems compared with physical illness.  flagged this up in a Guardian article last Wednesday. He stated:

The evidence is mounting that people with mental health problems in particular are being failed by PIPs, with claimants reporting that the new system takes no account of the needs of people with conditions ranging from schizophrenia to severe depression. Figures released by the DWP in October showed that complaints about the PIP assessment process increased by 880% last year. The number of complaints that were upheld rose similarly dramatically, by 713%.

Below is a short extract: for the full post see link.

Kloey Clarke, 28, from Devizes in Wiltshire, has had severe anxiety and type II bipolar disorder for six years. “I’m scared to leave the house,” says Clarke, who does not feel emotionally or physically stable enough to hold down a job and relies on her husband for care and support. “I have a constant fear of dying. I can’t socialise and I can’t communicate outside [the house].” For four years, Clarke depended on a Disability Living Allowance (DLA). The DLA was replaced by Personal Independence Payments (PIPs) in 2012 – and phased in from 2013 – but she was receiving them for less than a year before she was reassessed by the Department for Work and Pensions (DWP) and told she no longer qualified.

Clarke believes that the assessment for PIP is aimed at people with physical disabilities and does not account for mental illness. “I was asked if I could walk 200 metres unaided. No, I don’t need a stick or an aid, but I do need my husband or someone with me. Can I talk to people face to face? I talk to my family when they visit, but can I speak to strangers? No.”

She has had panic attacks as a consequence of losing her benefits, she says, and her family is now struggling financially. They have had to visit food banks twice since being rejected for PIP, but Clarke’s pride has stopped her from going more frequently. “I just find it so degrading. I don’t feel as if I should be there. I feel that, if I just had what I deserve, then I wouldn’t need to be in that place; I wouldn’t need to take food from, say, homeless people.”

Clarke’s marriage and her relationship with her children are suffering. “I’m useless to them, I’m not half the mum that I could be. I haven’t got enough funds. The government has no idea what these types of assessments do to people with mental health [issues]; how much it takes to walk into that room and talk about something so personal and then be told you aren’t ill enough.”

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The report says the government should consider enhancing protections for employees with mental health conditions in the Equality Act 2010. Photograph: Alamy Stock Photo

Disturbing news broke this week, though it was not a complete surprise to me, as someone who worked in the mental field for more than 30 years. The BBC reported on it extensively and this link is to the article by Haroon Siddique on the recent report by Thriving at Work. The discrepancy they report between those with physical and mental health problems is unacceptable:

… the number of people forced to stop work as a result of mental health problems was 50% higher than for those with physical health conditions.
Below is a short extract extract. For the full post see link.

Thriving at Work report commissioned by government urges employers to commit to six core standards around mental health.

About 300,000 people with a long-term mental health problem lose their jobs each year, a review commissioned by Theresa May has found.

The Thriving at Work report, published on Thursday, puts the annual cost to the UK economy of poor mental health at up to £99bn, of which about £42bn is borne by employers.

The authors – the Mind chief executive, Paul Farmer, and the mental health campaigner and a former HBOS chair, Dennis Stevenson – said they were shocked to find the number of people forced to stop work as a result of mental health problems was 50% higher than for those with physical health conditions.

Farmer said the evidence suggested it is still a taboo subject in many workplaces. “The picture is that there are very significant numbers of people in work with mental health problems but there are significant numbers who are not,” he said.

“We think that the reasons for that are a combination of a lack of support, lack of understanding within some workplaces and a lack of speedy access to mental health services. Sometimes in organisations people feel themselves excluded as a result of their mental health issues and sometimes people don’t necessarily spot that somebody is struggling.”

Farmer and Stevenson said that the challenge was bigger than they had envisaged when instructed by the prime minister, but that with action dramatic changes could be achieved over the next 10 years. They said they hoped that the number of people with long-term mental health problems who lose their jobs could be reduced to the same level as those with physical conditions.

They found that about 15% of people at work have symptoms of an existing mental health condition, which they said illustrates the fact that given the right support they can thrive in employment.

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snow

As I am dealing at the moment with my attitude to psychiatry it seemed worth re-publishing this from 2013, whose section on Journals Revisited describes the kind of disillusioning encounter that reinforced my scepticism about psychiatry as a complete and satisfying explanation of mental health problems. I had always felt the context of such problems was always more complex than unsupported speculations about brains and genes.  

I was recently at a national Bahá’í meeting. Within two hours of getting there, three people at least had asked me had I done my story for the Histories Project website yet. My first response was that the story of my becoming a Bahá’í – well, it was more of a declaration of intent, meaning that I intended to work at treading the Bahá’í path as effectively as I could – was basically fairly boring.

That didn’t seem to convince anyone so I stopped trying to explain that as a bookworm I didn’t have a dramatic encounter with a charismatic speaker, a life-changing mystical experience or participate in a totally mind-blowing meeting. I just read a book, then bought some more books and read them double quick, met a few warm and accepting people to ask questions of, then decided it made sense and joined the Bahá’í community. Something like that. It’s why I’ve never blogged about it in detail really. Anyway when I got back from the meeting I set about writing my story (eventually, if I pass it on, you’ll find it on the UK Baha’i histories site).

Journals Revisited

In doing so, I had to go back through my journals of that time and check out some dates. Shades of Becket’s Krapp’s Last Tape again (see earlier post). Becket’s monologue situation is that ‘It is Krapp’s 69th birthday and he hauls out his old tape recorder, reviews one of the earlier years – the recording he made when he was 39 – and makes a new recording commenting on the last 12 months.’ I’m just a year late this time.

As I read, I was amazed that I had got one key date wrong – I was still doing clinical placements until the end of September 1982 – I thought the course was all over by July, but that was only the academic bit.

The journal is full to the brim of desultory ruminations on the work I was doing on placement:

2nd September 1982: It has been a wonderful day – ploughed brown earth under the warmth of a mellow sun against a background of subdued green. However, not even such a day can remove the oppressive feel of the mental hospital to me. It is not an oppression that resides in any obvious way in the buildings or the layout even, unprepossessing as those are. Ugliness is not necessarily oppressive. Somehow the spirit exuded by the place as a whole is one of immutable and dehumanising tradition.

Today’s ward round, which I attended as a guest, was an emblem of that. Dr X., who is lugubrious and yet admirably meticulous, was on leave. In his stead was Dr Y, short, greying, shrewd and abrupt, with a slightly disarming affectation of bumbledom to mask the steel of his prompt authority. With him in the driving seat, and Dr W., the Registrar, and Mr Z., a nurse, in attendance, the ward round was steered into oppressive backwaters of psychiatric practice.

Dr W: We can’t give her medication on a 25. It’s illegal.

Mr Z: Since when is it illegal, doctor, to give a patient medication?

Dr W: We can’t on a 25.

Mr Z: If we did only what ’twas legal there’d be few people helped, to my way of thinking.

Dr Y: Should it be a 26 she’s on, d’you think doctor?

Dr W: Yes, I do. She needs medication.

25 and 26 refer to parts of the Mental Health Act at the time. Section 26 allowed you to force someone to take medication, but only if a certain level of risk was reached: Section 25 did not. The patient in question had just been ushered out of conference after delivering a loud long uninterruptible and paranoid harangue. She was clearly not going to agree to take medication voluntarily. What was disturbing was that there was no evidence to indicate that she was a danger to herself and/or others.

I think my somewhat self-righteous anti-psychiatry stance at the time, which had been rooted in my former socialist perspective and shaped by my experience of People Not Psychiatry, may have blinded me to the possible teasing irony of the nurse’s comments in the face of a doctor’s somewhat abrupt and prissy manner. The final point probably still stands though and raises the question of whether I should have brought it up myself at the time – the pros and cons of which it doesn’t appeared to have occurred to me to mention in my account.

This slight distortion of dates was bad enough, but even more surprising was the fact that the journal contained no mention whatsoever of the earlier moment I remember so well.

The Winter of my Discontent

Much of the second year of my Clinical MSc, from late 1981 onwards, was a very testing time. I was undergoing significant upheavals in my personal life and, perhaps as a result of the distress I was feeling, had also made at least one very poor decision, which impacted adversely on others as well as on myself. I was extremely distressed by all this, particularly because I had brought most of this on myself and could also see how others were suffering too. By Christmas, I knew I needed help to sort the situation out and rectify what I could in terms of damage done, but I couldn’t see where to turn.

To my astonishment, in early January 1982, I found myself alone in a snow-bound cottage in the middle of Sussex, a complete unbeliever as I thought, on my knees in tears saying, ‘God, if you exist, please help me now.’ It was a short prayer, if prayer it really was, but it was undoubtedly intensely felt. I was on my knees a lot longer than it took to say those improbable words. Interestingly, I was writing lots and lots of poems at the same time – some of them the best I’ve ever written. The poems don’t mention the prayer either but they were undoubtedly influenced by the weather.

My poetry lacks bravery.
Sunlight on snow
Says everything I need,
But when I go
None will know how,
Under my frost,
Songs were silenced.

Harvest Time

Not a word about the prayer anywhere at all! Very strange! I don’t doubt that it happened but it seemed as though I had devoted acres of paper to recording far less important facts about my life and neglected some really critical moments.

ScruttonPerhaps most surprisingly of all, though I have a huge number of memories about the period of this life-changing decision, most of which I have included in my draft of my story, none of them are in my journal. There is a short two paragraph entry there on 20 December 1982. It reads:

On 25 November 1982 I borrowed Scrutton’s book on the Bahá’í Faith from the library. On Friday 26 November I went down to the Bahá’í centre because, so closely did what was described correspond to my ideal, that I could not believe it. I bought half a dozen books, talked to several people, and soaked up an atmosphere of love more intoxicating than any wine I have ever tasted before.

On 2 December, I declared as a Bahá’í and I’m still utterly convinced I did the right thing. . . . . . [People] feel it could be another one of my transient and embarrassing enthusiasms and can’t understand my need for a religion in the first place. I feel that I will still be a Baha’i in 20 years time. Time will tell.

And, it seems, I am still working at it – after more than 30 years.

Summoning up Remembrance

The absence of evidence in the journal, when considered in the light of how treacherous I have found my memory to be, may indicate that the whole process has been heavily embroidered in my mind. Its treachery came home to me as a result of a conflict between my journal and my memory which I have blogged about before and which I will be republishing shortly.

Friern corridor

The corridor at Friern Barnet (not the hospital referred to in the post though I did work there later). For the picture’s source see link.

When anyone has asked me tell them about situations where my declaration as a Bahá’í brought me into conflict with the assumptions of my profession as a psychologist I was prone to boasting of the time I went for an informal interview for a clinical post soon after I qualified. I was walking with the neuropsychologist, I said, down towards her office. She was dressed in a white coat so she looked like a doctor from the back. The only thing missing was a stethoscope.

As we walked she cast a sideways glance at me and said: ‘Thank goodness Blackmore has finally put paid to the idea of God, don’t you agree?’

‘Not really,’ I distinctly remember saying,’I have an idea about God that I believe in.’

She glared at me and we walked the rest of the short way to her office in silence.

I come out of that version of events reasonably well and believed, until late last month, that this was exactly what happened. Until, that is, I read my journal of that period looking for the page reference. Imagine my feelings when I discovered, in my own hand-writing, an almost completely different version of events. First of all it happened in September. I didn’t hear about the Baha’i Faith until November. First hole below the waterline. I wrote:

She wore a white coat [at least I got that right] with her name written on a badge. My revulsion against psychologists who wish to masquerade as doctors was barely containable. And when I heard her mouthing with obvious contempt such things as ‘. . . .people who don’t realise that the mind is separate from the brain’ I did not know what to say. . . . .

All I could say was ‘I haven’t thought about it a lot.’

‘I’m very sorry to hear that . . . very sorry . . . I’m very sorry to hear that indeed.’

Quite why I couldn’t fight back I don’t know. Perhaps my feelings were running too high – they were certainly strong by this time. I just wanted to get out, I think.

According to my journal I mumbled some jargon strewn with impressive names but basically ducked the point. I believed the mind was not reducible to the brain but couldn’t say so.

The accounts, though they have a kernel of common truth, couldn’t be more different. When I had become a Baha’i I did speak out but definitely not then and not in the way I convinced myself it had happened. I clearly didn’t want to remember my craven evasion so I backdated my eventual moral courage and believed my own propaganda.

This might have been another reason why I have been so reluctant to go public with the story of my joining the Bahá’í community. How much of what I thought I remembered was, in fact, accurate?

To my relief, my memory of the basic details I quoted above was correct, which is encouraging.

Less Surprising than I thought?

What was still surprising, and which I had also forgotten, was how preoccupied with spiritual issues I had been in the months between my conditional prayer and my decision to join the Bahá’í community. I wrote copiously on the topic and it would be tedious in the extreme to quote everything but it’s worth sharing a taster, I think. At the end of August that year I wrote (emphasis in the original):

I have a burning desire to wipe the slate of my life and mind completely clean – and begin again differently – to polish my mind until it shines smooth and clear, revealing the true grain of its essential nature to the world and reflecting the world in the clarity of its shine.

The closeness which which this resembles quotations from Bahá’í Scripture feels slightly uncanny:

O My Brother! A pure heart is as a mirror; cleanse it with the burnish of love and severance from all save God, that the true sun may shine within it and the eternal morning dawn. Then wilt thou clearly see the meaning of “Neither doth My earth nor My heaven contain Me, but the heart of My faithful servant containeth Me.

(The Seven Valleys: page 21)

Not exactly the same, obviously, but strangely parallel. Revisiting journals is an oddly unsettling but also somewhat reassuring experience. I think on the whole the surprises it triggers make it worthwhile – at least now and again. I’m not sure I would want to do it too often!

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Suffering is life.

(Thomas Szasz quoted by James Davies in Cracked – page 276)

I was walking back from town one day when my phone pinged. It was a message telling me my book was ready for collection from Waterstones. I was puzzled to begin with then the penny dropped. Just before my birthday someone spotted that I had scribbled, in my list of books to buy, the title of Cracked by James Davies.

I turned round and headed back to town again. When I picked up the book, for some reason I wasn’t impressed by its cover. Maybe the words ‘Mail on Sunday’ put me off, though Wilf Self’s comment helped to redress the balance.

Anyhow, for whatever reason, I didn’t get round to reading it until after I’d finished Rovelli’s Reality is not What it Seems. I’ll be doing a short review of that later, possibly.

Once I started Davies’s book I was hooked.

I’ve already shared on this blog a review of Bentall’s book Doctoring the Mind, which brilliantly, for me at least, brings the more grandiose pretentions of psychiatry back to the earth with a bump. I quoted Salley Vickers’ verdict:

Bentall’s thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, “fatally flawed”. He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover “better” than those from the industrialised world and the aim of the book is broadly to suggest why this might be so. . . .

I summarised my own view by praising ‘its rigorous analysis of the misleading inadequacy of psychiatry’s diagnostic system, its powerful and carefully argued exposure of the myths surrounding psychotropic medications and their supposed efficacy, and its moving description of the critical importance of positive relationships to recovery.’

The Davies book also covers much of this same ground and is equally compelling. What needs to be acknowledged is that he also takes the argument to another level towards the end of his book. He is concerned that we are exporting our Western model with all its flaws to country after country and goes on to explore other implications as well.

In the chapter dealing with the export issue he first summarises his case up to that point (page 258 – square brackets pull in additional points he has made elsewhere):

Western psychiatry has just too many fissures in the system to warrant its wholesale exportation, not just because psychiatric diagnostic manuals are more products of culture than science (chapter 2) [and have labelled as disorders many normal responses to experience], or because the efficacy of our drugs is far from encouraging (Chapter 4), or because behind Western psychiatry lie a variety of cultural assumptions about human nature and the role of suffering of often questionable validity and utility (Chapter 9), or because pharmaceutical marketing can’t be relied on to report the facts unadulterated and unadorned [and its influence has helped consolidate the stranglehold of diagnosis and a simplistic psychiatric approach] (Chapter 10), or finally because our exported practices may undermine successful local ways of managing distress. If there is any conclusion to which the chapters of this book should point, it is that we must think twice before confidently imparting to unsuspecting people around the globe our particular brand of biological psychiatry, our wholly negative views of suffering, our medicalisation of everyday life, and our fearfulness of any emotion that may bring us down.

I can’t emphasise too strongly the value of reading through the details of his treatment of all these other aspects. I am of course aware that physical medicine, even though there are biological markers for diseases in this sphere unlike in mental health, has not been exempt from the disingenuous manipulation of data and unscrupulous marketing methods practiced by the pharmaceutical industry, as Malcolm Kendrick’s book Doctoring Data eloquently testifies, but the scale of that abuse is dwarfed in the arena of mental health – and I mean arena in the fullest sense of that word: the battle here is damaging more ‘patients’ and costing even more lives.

Davies’s examination of exactly how this exportation of the psychiatric perspective is coming about is also disturbing and compelling reading. He adduces for example how skilfully drug companies have learned to read the reality of cultures into which they want to make inroads with their products, how effectively they target key figures in the prescribing hierarchy of professionals, and how astutely they now reach out to the public themselves so they will go to their doctors and request what the drug company is selling – all this to detriment of the many ways the social cohesion of the receiving culture has often (though not always, of course) been supporting those who are suffering from some form of emotional distress.

Where he takes his case next, in Chapter 10, I found both compelling and resonant. He is in tune with Bentall in seeing the importance of supportive relationships but, I think, explores that aspect somewhat more deeply.

He repeats basic points, to begin with (page 266):

What the evidence shows… is that what matters most in mental health care is not diagnosing problems and prescribing medication, but developing meaningful relationships with sufferers with the aim of cultivating insight into their problems, so the right interventions can be individually tailored to their needs. Sometimes this means giving meds, but more often it does not.

He then quotes research done by a psychiatrist he interviewed (page 267). Using two existing MH teams, Dr Sami Timimi set up a study comparing the results from two groups, one diagnostic, the usual approach, and the other non-diagnostic, where medication was given only sparingly, diagnosis was hardly used at all, and individual treatment plans were tailored to the person’s unique needs.’

In the non-diagnostic group the psychiatrist spent far more time exploring with his clients the context of their problems.

The results were clear (page 269):

Only 9 per cent of patients treated by the non-diagnostic approach continued needing treatment after two years, compared with 34 per cent of patients who were being treated via the medical model. Furthermore, only one person from the non-diagnostic group ended up having to be hospitalised, whereas over 15 people in the medical-model team were referred for inpatient hospital treatment. Finally, the non-diagnostic approach led to more people being discharged more quickly, and to the lowest patient ‘no-show’ rate out of all the mental health teams in the county.

Davies also interviewed Dr Peter Breggin, a US psychiatrist who is critical of the medical model. Breggin explained his viewpoint (page 279):

Most problems are created by the contexts in which people live and therefore require contextual not chemical solutions. ‘People who are breaking down are often like canaries in a mineshafts,’ explained Breggin. ‘They are a signal of a severe family issue.’ .  . . . For Breggin, because the medical model fails to take context seriously – whether the family or the wider social context – it overlooks the importance of understanding and managing context to help the person in distress.

Davies quotes Dr Pat Bracken as singing from the same hymn sheet (page 273):

We should start turning the paradigm round, start seeing the non-medical approach as the real work of psychiatry, rather than as incidental to the main thrust of the job, which is about diagnosing people and then getting them on the right drugs.

It’s where he goes next that I found most unexpected but most welcome to my heart. He leads into it with an interview with Thomas Sasz just before his death at the age of 92 (page 276). He asks Szasz, ‘why do we believe as a culture that suffering must be removed chemically rather than understood in many cases as a natural human phenomenon, and possibly something from which we can learn and grow if worked through productively?’

Szasz’s response is fascinating:

Our age has replaced a religious point of view with a pseudo-scientific point of view. . .   Now everything is explained in terms of molecules and atoms and brain scans. It is a reduction of the human being to a biological machine. We don’t have existential or religious or mental suffering any more. Instead we have brain disorders.

Davies summarises Szasz’s position on psychiatry (page 277): ‘It had become deluded in its belief that its physical technologies, its ECT machines and laboratory-manufactured molecules, could solve the deeper dilemmas of the soul, society and self.

Bracken’s view on this brings in capitalism (page 278):

What complicates things more is that we also live in a capitalist society, where there is always going to be someone trying to sell you something… In fact, some people would argue that capitalism can only continue by constantly making us dissatisfied with our lives.… You know, if everybody said I am very happy with my television, my car and everything else I’ve got, and I’m perfectly content with my lifestyle, the whole economy would come shattering down around our ears.

He continues (page 279):

What we customarily call mental illness is not always illness in the medical sense. It’s often a natural outcome of struggling to make our way in a world where the traditional guides, props and understandings are rapidly disappearing… Not all mental strife is therefore due to an internal malfunction but often to the outcome of living in a malfunctioning world. The solution is not yet more medicalisation, but an overhaul of our cultural beliefs, a reinfusing of life with spiritual, religious or humanistic meaning with emphasis on the essential involvement of community, and with whatever helps bring us greater direction, understanding, courage and purpose.

Unfortunately psychiatry, as with economics according to the writers of Econocracy, is failing to train psychiatrists in the adoption of a critical perspective on their own practice. So, he concludes, the pressure to change perspective has to come from outside the psychiatric system. He quotes Timimi again (page 285):

The things that get powerful institutions to change don’t usually come from inside those institutions. They usually come from outside. So anything that can put pressure on psychiatry as an institution to critique its concepts and reform its ways must surely be a good thing.

So, it’s down to us then. For me, promoting this book is a start. We all need to think, though, what else could be done, whether as a patient, a volunteer, a friend, a family member, an MP, a clinician or simply a citizen.

Currently, help is often tied to diagnosis. One psychiatrist quoted in this book is concerned that if categories of mental disorder are not confirmed as diseases, services will never be funded at the required level, the level, say, at which cancer services are funded. Surely, though, if opinion shifts to a tipping point not only the greater humanity of non-diagnostic treatments but also their relative cost effectiveness must carry the day in the end. But opinion will only shift sufficiently if we all play our part.

I know! I’ve got it.

You all could start by reading these two books. How about that?

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The danger threatening modern man is that instead of being a complete person at any given moment, he will be split into unrelated fragments . . .
(From The Artist as Citizen Thomas Lysaght – page 143 in The Creative Circle edited by Michael Fitzergerald)

hollis-on-thomas

My recently reactivated interest in the disturbingly wide impact of trauma in various forms on our lives leads me to republish this sequence on Edward Thomas. I feel I underestimated the influence of his childhood on his struggles as an adult.  Most of the texts I explored for this review drew a veil over any of the details of his early life. Only Andrew Motion’s book about his poetry gave any real hint. His depression, I speculate briefly in this first post, may have had its roots in his problematic relationship with his father: to describe this relationship Andrew Motion uses the word ‘tyrannise’ in his account of Thomas’s poetry. A brief trawl of the web has so far produced nothing else, so I am stressing here the importance of this hint as a key to his later life. I need to follow this up more deeply when I have the time. 

I have just finished reading Matthew Hollis’s absorbing account of the last years of Edward Thomas’s life. I was particularly struck by certain parts of the arc of his life’s trajectory at that period. When the book begins we are watching a man fighting with himself and with his perceived lot in life. He is seemingly trapped in a dead end – no sign of any exit short of death, in fact. We watch his emerging realisation that he is a poet, an epiphany facilitated by his warm friendship with Robert Frost. The ice bound wilderness of his previous inner existence melts into a creative springtime. At the same time as he begins to move towards and get to grips with his true vocation, he is debating whether to enlist in the so-called Great War. Hollis’s description of these various stages in the unfolding drama is compassionate and gripping, even when, as I did, you know the bare bones of the story already.

I hope I won’t be spoiling anyone’s enjoyment of this wonderful book if I look at these three stages of Thomas’s life in more detail using Hollis’s account as a springboard. I’ll be focusing on some of their implications for my obsessions with character, creativity, compassion and mental health. I can’t cram it all into one post so I’ve split this set of reflections into three. (For those who are interested there is a moving November 2013 interview with Hollis on the BBC website at this link.)

His hack work and the maintenance of his depression

Much of Edward Thomas’s bitterness in the opening years of this account stems from his having to slave away at what he experienced as hack work in order to feed his family. He had married young and had his wife and three children to provide for.

To see this as alone responsible for his depression would be to simplify things rather, in that the depression predated his hack work and also his marriage as an undergraduate (page 20):

Thomas had been plagued by depression from before his university days at Oxford. There, he fought to shake it out of himself. He tried drink and opium, took up rowing and rowdiness, but could not hold the bleak moods back. When the dark thoughts overran him, he told himself that he valued life too much to take it away or that he was too sedentary to go through with ending it; but in recent years he had become harder to console. In advertising his sorrows, as he put it, he had punished his family, decimated his friends and broken down his self-respect. ‘Things have been very wrong,’ he told his old friend Jesse Berridge in February 1913. ‘Health is now definitely bad – not mere depression – and I don’t know how it will develop. . . .’

It may have had its roots in his problematic relationship with his father: to describe this relationship Andrew Motion uses the word ‘tyrannise’ in his account of Thomas’s poetry. Thomas at least once came terrifyingly close to suicide but was unable to carry through his plan (ibid).

He hated [his wife Helen’s] fussing and her pretence that all was well, but the loathing he felt toward his own cowardice was stronger. Unable to do what he believed he should and put an end to his suffering, he was left to berate himself bitterly: ‘I’m the man who always comes home to his supper.’

Some of the prose work he did contained clues to his future greatness as a poet. He was a discerning and courageous critic of the work of other poets. He also wrote with deep feeling and great skill of the English countryside and those who lived close to it. He was completely blind to the potential planted in what to him seemed such unpromising soil.

The impact of his depression on his family

He comes across from all accounts as a fundamentally decent man whose dark moods poisoned his relationships with others, and there is no real hint of a constructive link between his depression and his creativity. He was completely trapped in a demoralising vicious circle (page 17):

The relentless, ungratifying work left him exhausted and bitter, while the din of family life served only to worsen his mood. In poor spirits he treated his family cruelly, scolding the children and reprimanding his wife, and the more he did so, the worse his spirits became.

He recognised how much his wife and children suffered from his moods but seemed powerless to protect them from himself if he stayed (page 19):

. . . . the family had joined Edward for Christmas, cared for by Helen, the woman he had married thirteen years ago, who loved him with a passion that he could no longer return.

And he also seemed powerless to leave them for good and set them free from him on a permanent basis either, not that they would have welcomed that idea at all (page 27):

‘What I really ought to do is live alone,’ he told Jesse Berridge. ‘But I can’t find the courage to do the many things necessary for taking that step. It is really the kind Helen and the children who make life almost impossible.’ Somehow they adapted to the outbursts and the absences.

The cost of keeping the family together was cruelly high (page 28):

The absences were crippling to Helen. She was warm and impulsive, a product of her father’s free‑thinking influence, but her untidy spontaneity made her a hopeless housekeeper and a poor cook to Edward’s irritation. . . . . It was her bohemianism that allowed her to ‘manage’ his disappearances emotionally but it was these same unconventional attitudes that left her isolated and wounded when he left.

There is an interesting clue we are given late in the book to what might have been going on within him at this time and beyond (page 230):

He longed for someone to break through the edifice that he had put around himself, an edifice designed, he said, to protect his humility.

The chances of finding anyone in England at the time with the necessary expertise was remote in the extreme (page 29):

Psychology in England was in its primitive stages before the war, with psychosomatic disorders little understood.

Hollis seems to feel with Thomas that the depression which dogged him was positively related to his creativity (ibid):

Thomas himself was not uncritical of his own condition, nor was he unappreciative of the energies that it produced within him. Aware that the depression was also a source of creativity, he had in the past been ambivalent about attempts to purge it. ‘I wonder whether for a person like myself whose most intense moments were those of depression a cure that destroys the depression may not destroy the intensity,’ he wrote in 1908, adding, – a desperate remedy?’

Robert Frost

His later history, which I will be dealing with in the other two posts on this subject, calls this view into question. An easing of his depression did not seem to diminish the strength of his experiences or his capacity to translate them into words – but more of that later.

He did feel at one point ‘in 1912 [that] he had finally met an individual [Godwyn Baynes, later a follower of Jung] who could help with a subtler understanding of his suffering.’ Initially Thomas was Baynes’s only ‘client.’ His optimism was relatively short lived and the gains temporary. As Baynes widened his clientele Thomas’s belief in him shrank.

As we will see, his decision to enlist and his realisation that he was writing real poetry eventually combined to decrease his susceptibility to depression. This had a significant positive effect on his relationship with his family (page 308):

. . . then he sympathised with [Helen’s] visit to town to have a bad tooth taken out. ‘I hope you don’t dislike the dentist who took it away.’ It was a care and kindness that Thomas would show more of in the weeks ahead.

Not that the weeks ahead were without intensely painful moments as the time for his final departure to the front drew closer (page 310):

. . . . to ease the tension [he] took out his prismatic compass and showed her how to take a bearing from it; when she cried he closed the casing and put the instrument away. Helen could no longer rein back her desperation and felt engulfed by an uncontrollable grief of a kind that would plague her in the years ahead. She would recount his tenderness in that moment. She wrote of his gentle ability to soothe and steady her, to give her both the emotional and the physical reassurance for which she so longed. He read to her and carried her to the bedroom in his greatcoat. ‘Helen, Helen, Helen,’ he had said, ‘Remember that, whatever happens, all is well between us for ever and ever.’ When the morning came, she stood at the gate and watched him disappear into the mist and snow. Edward for his part recorded nothing of the details, only this entry in his diary: ‘Said goodbye to Helen, Mervyn and Baba.’

Such intense tenderness would have been impossible to him before he became a poet and a soldier. But consideration of those developments will have to wait until next time.

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