Are we over-medicalizing suffering?

There’s been an extraordinary shift in British emotional culture in the last 20 years.

We’ve gone from being the culture that supposedly never talks about emotions, to the one that never shuts up about them.

Every day is World Mental Health Day in the UK. Every day there’s a new campaign to promote well-being, every day a new celebrity bravely discloses their battle with mental illness (or mental health, as it’s now called).

Like countless others, I’ve been involved in this cultural shift. I’ve spoken about my own experience of mental illness and recovery, to challenge the stigma I felt growing up and to promote emotional literacy, self-care and access to psychotherapy.

But no good deed goes unpunished. Many well-intentioned actions have unintended consequences.

In the case of the well-being movement, one of the unintended consequences, arguably, is the over-medicalisation of suffering.

What would once have been considered normal if painful experiences — shyness, sadness, grief, anxiety — are now classified as symptoms of mental disorders requiring medical treatment.

A diagnosis can sometimes be helpful. It was certainly helpful for me to learn that I was suffering from somethings called ‘post-traumatic stress disorder’ and ‘social anxiety’. I realized many others had very similar negative thinking patterns to me, and there was a proven way to change this.

However, the risk of the diagnostic model of mental illness is you decide:

• There is something wrong with your basic neural functioning and essential self

• It’s rooted in your brain chemistry and genes

• It is out of your control

• The only solution is drugs provided by a psychiatrist, or therapy provided by a psychotherapist. It’s out of your hands in other words.

• The human race is then divided into two species — those who have a disorder, and those who do not (as opposed to the entire human race who sometimes experience difficult emotions).

Well-intentioned celebrities like Ruby Wax and Stephen Fry who speak out about their mental illnesses to challenge stigma only perpetuate this worldview. Mental illness is just like physical illness, they say. You need chemical help for your broken brain. This is a simplification at best, and at worst untrue and harmful.

As more and more people see their suffering through this medical and diagnostic model, there is an ever-growing sense that we’re in a ‘mental health crisis’, with ever more desperate calls for more therapists and more pills.

Today, members of Gen Z are four times more likely to be diagnosed with a mental disorder than baby boomers. And more and more people are on mood-altering drugs. 7.3 million people are prescribed anti-depressants in England — 16% of the adult population — and half of them are taking anti-depressants long-term. This is despite the fact they’re only slightly more effective than placebo, can have negative side-effects, and are proven to lead to dependency and withdrawal.

There are commercial interests pushing the diagnostic / medical model of suffering. Pharmaceutical companies actively sponsor the researchers who create the diagnoses and research the chemical cures. 88% of the psychiatrists who decided which disorders to include in the DSM IV, the industry bible, had financial ties to drug companies. With the DSM V, the latest version, 21 members of the 29-person task force received financial assistance from Big Pharma. Nearly all clinical trails of psychoactive drugs are funded by Big Pharma, which is why negative results are so rarely published.

Then there are the armies of well-being experts — psychiatrists, psychotherapists, life coaches, organizational therapists, mental health charities, me — telling us we’re messed up but they can fix it.

This week, for example, news stories warned of an epidemic of mental illness at work, with 67% of Gen Z employees leaving a job because of mental illness. How many?? It turns out the survey was by a company called Mind Share Partners, who used a very broad definition of mental illness (feeling sad, anxious or hopeless for two weeks). And guess what, they sell mental health advice to companies.

The consequence of this medicalization of suffering is a learned helplessness. ‘I’m sick, I have a disorder, I need medical assistance, quick!’

It leads to a sort of infantilization of adults, who are treated like idiots unable to take care of their own well-being.

For example, the British royal family launched a new campaign called Every Mind Matters this week, with a website offering advice such as ‘if you’re feeling lonely, phone a friend’.

The Catholic priest and radical philosopher Ivan Illich, who I mentioned a fortnight ago, warned about this trend in his 1974 book Medical Nemesis: The Expropriation of Health.

He warned healthcare was well on its way to becoming a world religion, with its own priests and dogmas. It was guilty of iatrogenesis — harm caused by structures intended to cure.

It was particularly guilty of cultural iatrogenesis — the destruction of culturally traditional ways of dealing with pain, illness and death. We’ve lost our own wisdom, our own self-care practices, and look dumbly to the health-experts.

I agree, to some extent.

Christianity has been replaced by numerous religions — the religion of capitalism, the religion of the self, and also the religion of health and well-being.

The religion of health and well-being draws on some old religious / spiritual practices — Stoic practices in CBT, Buddhist practices in mindfulness, yoga, and so on.

But we can learn these ancient wisdom practices ourselves as well — we don’t need to wait weeks or months to see a therapist or psychiatrist to tell us about them.

And the new religion of health and well-being dropped the old religious worldview that the human condition is one of suffering.

That idea is at the heart of Buddhism, Stoicism, Christianity, and any old religion worth its salt.

If you look at medieval Christianity, for example, it has the basic idea that this life is a vale of sorrows, practically the entire human race is deluded or even mad (especially the powerful), and we will only be liberated in the afterlife (maybe).

Buddhism likewise argues that human life is suffering, that almost the entire human race is deeply deluded, and we will only be liberated after many lives of spiritual practice.

The new religion of health and well-being, by contrast, says ‘you should be happy and healthy. If you’re not, that’s a disorder. Here’s some CBT or some pills. Now you should be happy and healthy.’

It also says ‘we’re at war with illness, at war with cancer, at war with depression, at war with suffering, at war with death, and we will win.’

That’s clearly bonkers. The war on pain, illness and death will never be won. But it justifies an ever-expanding bureaucracy.

(Of course, the old religion wasn’t much better — Christianity also said ‘you are sick, and the only cure is to kneel to us, the experts. It also led to a bloated and self-perpetuating bureaucracy.)

The spiritual solution to suffering, then, would be firstly to accept that it’s part of the human condition, and to be expected; second, to look deeply into the nature of suffering in our own restless and dissatisfied mind, to try to find its root, which the great spiritual teachers tell us lies in egocentricity.

Until we get to that root, our well-being campaigns are doomed to failure.

But wait a second.

Is the spiritual or contemplative solution to mental suffering also somehow deficient?

There’s an alternative approach, which you could call the activist / social justice response.

But I’ll talk about that next week.