Suzanne Martin writes:
I was reflecting back over my own awareness of mental health over the years. I still get in a tangle over terminology as I attempt to move myself away from my own implicit biases, the biases my culture feed me and some of the unhelpful aspects of the psychotherapy training I had. It comes down to relationship not labelling – we can help each other when we recognise the need for comfort in distress. But first we have to break out of some tangled ideas.
The first tangle is around the phrase mental health – well we all have that don’t we? Whether our mental health is good or temporarily compromised or a long-term struggle we are talking about the same basic concept when we say mental health. Yet we tend to encounter the term only when someone doesn’t have good mental health. That means that the term ‘mental health’ really means ‘mental illness’. Why are we unable to be straightforward about the difference between wellness and illness?
The second tangle is around the fact that there is no clear division between good and bad mental health. When I started out on my adult life I had any number of problems holding myself together but I never once considered I was attempting to preserve my mental health. I thought mental health was about ‘madness’ and madness was about something genetic or flawed. I had no idea then that I was afraid of my own potential to become mentally ill when I saw distress as something that happened to ‘them’ and not ‘us’. It took a while to realise that there was no us and them. When we dwell in this view of mental illness we do not connect with each other or acknowledge the vulnerability of being human. We avoid relating to each other when fragility rears its head.
The third tangle is that we deny the fact that our mental well being relates closely to social inequalities. I was able to hold myself together because I had some good relationships, some resources and educational opportunities that gave me some social capital. These assets amounted to resilience which in turn shielded me from some of the threats I encountered in everyday life (and everyday sexism). Mary O’Hara wrote about these links in her article for the Guardian following the publication of a report by the World Health Organisation (‘Inequality is bad for your health’ 2009). Interestingly the UK is identified as paticulalry problematic in this regard because of the gap between rich and poor. This quote from the article gives a sense of the mountain we still have to climb to put this imbalance right: ‘The adverse impact of stress is greater in societies where greater inequality exists and where some people feel worse off than others. We will have to face up to the fact that individual and collective mental health and wellbeing will depend on reducing the gap between rich and poor.’
The fourth tangle is in our failure to ask about the experiences that have led someone into a state of mental distress. I work with men and women who have been psychologically, physically and sexually stamped on in their relationships from childhood onwards. What astounds me is that there should be any question about the cause of their mental distress. And yet there is. How many countless people are there wondering around with stigmatising labels stuck over their mouths so that when they speak about abuse we can’t hear them? When I was young, feminism was helping me to challenge terms like ‘hysterical’. Who will help us to challenge terms like ‘Borderline Personality disorder?’
So roll on the untanglers or at least the people who have helped me to untangle my own views. I was lucky to work with Jennie Williams from Inequality Agenda and through her with the National Institute for Mental Health in England before it was disbanded in 2009. Inequality Agenda ran some excellent training on women’s mental health bringing together trainers with academic, work and personal experiences of mental distress. It was through Jennie that I began to unlearn a substantial number of diagnostic categories and their attendent labels. My psychotherapy training had aligned itself fairly comfortably alongside psychiatry which meant that we talked in terms of various ‘conditions’ which in turn had various recommended interventions. Jennie re-introduced me to the importance of relationship and I quickly discovered the most reliable labels: poverty, poor housing, gender, race, abuse history, disability, immigration status etc.
It took Richard Bentall, Suman Fernando, Lucy Johnstone and Peter Kinderman to articulate for me the reasons why diagnosis or the ‘disease model’ was so flawed, so questionable and so uneccessary. They (and others) have demonstrated through work, thought and research that the beneficiaries of the disease model are the drug companies and not the distressed individuals. The categories are imprecise and unscientific as was demonstrated in the Horizon documentary ‘how mad are you?’ (BBC2 2008). The danger with obtaining a diagnosis is that your experience of domestic violence, sexual abuse, neglect, bullying etc could start to be attributed by others to your psychological health. Listen to the Archers and you will see how an abusive partner, Rob Titchener, uses this tangle to undermine his wife Helen’s accounts of his abusiveness.
If inequality is implicated in mental distress then why would any of us accept a diagnostic label? Once you have the label you are marginalised and that marginalisation will add to your distress. So in a week of awareness raising why not watch the documentary and read some of these books. What you will discover is that responding to mental distress is not the sole preserve of the highly skilled – we can all offer comfort and respect to each other at vulnerable moments. I may not be able to cure cancer or deliver a baby but I don’t have to avoid the dying or stay clear of heavily pregnant women.
O’Hara, M. (2009) Inequality is bad for your health – The Gaurdian http://www.theguardian.com/society/2009/mar/11/mental-health-inequality
Williams J, Stephenson D, and Keating F., (2014) A tapestry of oppression. The psychologist June 2014 Vol.27 (pp406-409) Avalaible at : https://thepsychologist.bps.org.uk/volume-27/edition-6/tapestry-oppression
Bentall, R.P. (2004) Madness explained: Psychosis and human nature. Penguin
Fernando, S (2010) The nature of ‘diagnosis’ in psychiatry. Available at:http://www.sumanfernando.com/Nature%20of%20diagnosis.pdf
Johnstone, L. (2000) Users and abusers of psychiatry: A critical look at psychiatric practice. Routledge
Kinderman, P., (2014) A prescription for psychiatry Palgrave Macmillan
The Archers: What effect has the Rob and Helen story had? http://www.bbc.co.uk/news/magazine-35961057