You can read the stats or you could just open your eyes. I know there is a crisis of mental health because there are so many very ill people wandering about. Some may be sleeping rough, but beyond that, on the buses or in the streets, I see and hear too many people in obvious psychological distress. This is before we begin to unpick the things not actually in front of us; the huge number of teenage girls self-harming (reports say a fifth of 14-year-old girls), the suicide rates for young men, the self-presentation of anxiety. The great “disappeared” who suffer from depression and spend chunks of their life invisible but incapable. At the same time, we are all encouraged to talk more about it. Does that help?
This extremely simple idea is a radical one. It is the basic underpinning of all counselling and psychotherapy. The alternative to the oral cure is chemical. Antidepressants and anti-psychotics are extremely useful for some, but not all people. They can be life-saving, but they are not a panacea. In the Times this weekend, Matthew Parris argued that it is wrong to spend so much on talking therapies and medication when their cost-effectiveness is unclear. But measuring the efficacy of these various treatments has always been problematic. The cost-effectiveness of treating unhappiness is unquantifiable but the insistence we need more money for mental health budgets is real. Acute psychiatric care is in crisis, with young people being sent 200 miles from their families as there are no beds. Police cells and prisons are full of people whose main crime is being mentally ill. Child and adult mental health services have huge waiting lists. GPs surgeries are full of those prescribed drugs for what is essentially poverty and loneliness. Those who can afford private therapy may find it helpful, others recoil from it. Bereavement and trauma is something some feel has to be lived through. There ain’t no cure for loss.
The profession of psychotherapy remains far too unregulated and offers a bewildering array of approaches, but at their base is one fundamental assumption, that it is better to talk about things than not. We may not need another “expert” to interpret what we say, but we need to be heard.
A therapeutic encounter is not a normal conversation, it is one in which you are listened to without judgment and can, in my limited experience, be a magical process. But how cost-effective is listening? And is it any more effective than common prayer? If we must quantify everything then yes, it is less cost-effective than CBT, in which in six weeks you may learn a few strategies to override the intrusive flotsam and jetsam in your own mind. Whether you can or will get to the root cause of your issue is not what matters: functioning better is the goal.
But none of this really gets to what this is all about – our mental health appears to be worsening. Instead of locating these problems in the individual, we surely have to look outwards. Symptoms are, after all, culturally and historically specific. The women Freud treated in turn-of-the-century Vienna often had partial paralysis, fainting fits, tics or difficulty in swallowing. Sometimes, they were mute or their legs and arms were numb. Their inner unhappiness was converted into visible physical signs. We don’t often see such symptoms now, instead there is cutting and purging and the all-purpose “borderline personality disorder” given to young women who don’t fit the diagnostic boxes. The suicide rate of young men is horrendously indicative of another kind of cultural failure. So we can talk about self-care and not bottling things up – and these are Band-Aids – but this mental health crisis is a political crisis.
Something about the way we live is making us unhappy and unable to function. Every self-help book and every act of self-love is a way for individuals to try to cope in a world that is deeply dysfunctional.
The shock is not that so many of us have poor mental health, but that more of us don’t.
