The Courage to Take Mental Health Seriously

I like this Guardian article by Jonathan Naess, who founded the mental health charity Stand to Reason:

Our deepest fear: taking mental health seriously?

Mental health patients should have more opportunity to make informed decisions about their treatment, says Jonathan Naess

Dr Paul Keedwell is clearly a remarkable psychiatrist, writes Jonathan Naess; not least because, like the proverbial turkey voting for Christmas, he is an advocate of less not more medication from psychiatrists of mild to moderate symptoms of depression.

Keedwell’s book is remarkable too for its profound respect for the subtlety of our experience of depression. Until recently stigma and discrimination has made it difficult to talk frankly about what it feels like to be depressed, and to look with clarity at what insights and benefits we may gain from it.

He argues convincingly from the new science Evolutionary Psychology that there must be some significant evolutionary advantage to depression (as well as the obvious costs) otherwise it would simply have been bred out of us by now. It should surely make us pause for thought before using powerful psycho-tropic drugs to blast away mild depression, if this experience has served our ancestors well for millennia.

His recommendation happens to be in line with current National Institute for Health and Clinical Excellence guidelines, albeit broadly ignored by many GPs and psychiatrists throughout the UK, not least because for years we have had scandalous under-investment in talking therapy with the result that there is often an eight-month wait to access cognitive behavioural therapy.

More worryingly, the announcement yesterday of the large study of published and the unpublished data from big pharma under their Freedom of Information Act, accessed from the United States regulatory body the FDA, revealed that service users may have been misled in placing too much confidence in SSRIs unless being treated for most severe forms of depression.

As psychiatrists like Keedwell leave behind the medical model, it opens up the possibility for us to make informed choices about a range of services. Stand to Reason has members with a wide spectrum of experience of mental distress including depression and of taking medication: some are passionately for whereas other are against. Similarly, Keedwell’s view of the “importance of resolving intrapsychic conflicts arising from childhood and infancy” is a bit too Freudian for my taste. Having tried both, CBT has been a far more effective tool for managing my mental health. For all the evidence, nobody has more information about our mental health than ourselves. Because one size does not fit all, we need to be passionate advocates for our right to choose.

Keedwell writes in today’s Guardian, “the British public seems to feel threatened” when discussing the positive aspects of mental illness.

When Nelson Mandela made his inaugural address to South Africans as their first black president in 1994, he said:

Our deepest fear is not that we are inadequate
Our deepest fear is that we are powerful beyond measure…
And as we let our own light shine, we unconsciously give other people
Permission to do the same.
As we are liberated from our own fears, our presence automatically liberates others.

High flown rhetoric, or a beautiful dream to think that this could ever apply to mental health? Stand to Reason is encountering the truth of Mandela’s words when engaging with companies in attempting to change workplace cultures. A senior HR professional from a big four accountancy firm last week explained to me the sorts of difficulties that teams can face, and the emotional intelligence needed to debrief effectively after an audit goes wrong. He then turned round and said, “You know, if we can get mental well-being at work right, it will make the rest seems like a piece of cake.”

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