Sunday, 4 August 2013

Walking the Black Dog

That mighty if diverse handful of people who regularly read this blog might be mystified as to why it seems to have dried up. There has been a distinct lack of rain round here lately but, no, that 's not the reason. It is certainly the case that the end of the summer term is a hectic time when it comes to paper-work so that does  take precedence but the overriding reason has been that I discovered I'd torn a retina. The upshot was that I really wanted to do as little as possible with my eyes for a few weeks. Anyway, enough. It received prompt treatment (full marks to the amazing NHS) and I've been told everything has healed up well. I've every reason to think that's that.

I've just read an interesting article by Will Self about psychiatry. In it, he highlights the lack of real science behind the claims "big pharma" make for their drugs and asserts that one day, current approaches to diagnosis and medication will be seen as no better than past, discredited (and often downright harmful) treatments. We've treated mental health issues medically over the years because we feel a social imperative to do so - not because we have real answers. Psychiatrists who do make a difference to people's lives do so not because of the diagnoses they make or the medications they prescribe but because they are skilled helpers.

I used to work in the helping professions and my job brought me into regular contact with psychiatry and, based on my own experience, I would go along  with what Self has to say. I would, though, ask the question, if psychiatry is bunk then how come anti-psychiatry (as advocated by R.D. Laing) has not evolved into a rip-roaring success? I don't ask this as a rhetorical question but as a very real question, as I do not feel I know how to answer it.

It may be that problems tend to cross our paths like London buses -none for an age, then several at once- but, over the past year, I've found myself listening to a frightening number of people (including, even, a waitress in a coffee-shop I'd visited)  who have to battle with the most seemingly intractable problems. (We certainly live in difficult times which, to put it mildly, doesn't help - over half those questioned in a poll recently said they were faced with financial problems that were out of control). Years ago I trained as a social worker. I don't think learning a bit of theory and a few skills makes one less "emotionally accident prone" - I've had my fair share of hard times and some of the people I've met in my work in the caring professions have had terrible problems of their own. But I do think  there are some things I learnt when I trained which could be taught in school as part of the mainstream curriculum. We teach people how to treat colds and cuts without going to the doctor - so why not some basic emotional problem solving? Areas covered -I'm sure you can think of more- might include the following. If they are already covered in some way then all I can say is that they need to be given more emphasis:

1. How talking makes you feel good but if you have to talk about your problems every week it's merely a treatment, not a cure.
2. Apportioning blame and solving a problem are not the same thing. It's the latter we should be more interested in.
3. Looking out for vicious circles. (When you find one, ask yourself what part are you playing in it? Change the script - and break the circle).
4. (At the risk of sounding glib) the importance of being kind.

Regarding physical health, we are comparatively well-aware that if we ignore warning-signs, we might end up presenting the doctor with a barely-treatable advanced condition. However, we tend to pay scant attention to our mental health (and to that of those around us) until the problems become so serious that they seriously interfere with our functioning. We tend to think we should "pull ourselves together" - everyone else does, don't they? This alone makes it hardly surprising that mental health treatments are seen as ineffective, as too often they only begin once the condition is well-advanced. Add to this Will Self's well-founded doubts about the effectiveness of the diagnoses and treatments we're talking about and the need for effective basic education in problem-solving and emotional well-being could not be more apparent.

If there were not "first aiders" and first aid kits in every workplace, if people were not aware of how to clean wounds and  treat pain and common bugs with Paracetamol, if there were no media campaigns urging us to eat healthily, or spot the symptoms of serious conditions, then surely we would be a lot less physically healthy in Britain and make more demands on our health services.  If we paid as much attention to our basic mental health self help as we do to our basic physical health, we would surely be happier on the whole and have less need to consult what Self amusingly calls the "black dog walkers".


Alan Burnett said...

Good to see you blogging again. I have missed your posts for their mixture of good writing and interesting approaches to subjects - today's post is a perfect example of this.

Joanne Noragon said...

Echoing Alan, good to see you back. A detached retina, wow. I thought those could just take one by surprise; glad yours was early and fixable.
I've walked black dogs in my time; it's important to keep after mental health, especially the little people we'll spin off into the world.

The Solitary Walker said...

Very good, very interesting indeed, Dominic! This shows, as is to be expected, your usual open, objective and sensitive mind. Don't believe all you read or hear, but come to your own conclusions, and fill in any inevitable gaps with generosity, is what I've also tried to adhere to.

Loren said...

When I worked as a caseworker in the bad-old-days, I was convinced that about all psychiatrists accomplished was to sedate people enough that they couldn't act on their thoughts.

Drugs have obviously improved since then, but the underlying theory seems to have remained the same. Sedation isn't quite the same as a "cure," in my opinion.

Dominic Rivron said...

Thanks for these comments.

Alan: It's good of you to say so - thank you!

JN: A retinal tear is a warning and needs fixing straight away, I've discovered! After 50 the jelly in our eyes changes apparently. It shrinks, sucking in the wall of the eye. Sometimes this pulls of the edge of the retina.

SW: Well put. Something about generosity of spirit could be worked into my list. Perhaps we're shy of "emotional education" because some aspects of it could be seen as 1984-like? In a democracy, so the argument (not mine) might go, perhaps one has to be free to choose between generosity and anger?

Loren: Good point. Interestingly, people have taken the sedation approach to extremes and tried inducing unconsciousness for a very long period of time in people in the hope that their problems would simply "go away". It doesn't work.

The Weaver of Grass said...

Good point Dominic about 'inducing unconsciouness' - I was part of this treatment programme (deep insulin) in the early 1950's. Sooner or later one has to sit down by oneself and have a good hard look at the facts and work a way through them. Just as my working through the VAT return today and getting the whole lot onto the right website led to a lifting of my spirits, so working out one's problems for oneself does tend to lead to a better outcome than getting someone else to work them out for you.
I think we all have highs and lows in our lives and we all have so called problems, although some of us see them as just that whereas others never get to that stage, blaming them on others until eventually they end up in a corner.

Jenny Woolf said...

I'm sorry to hear about your eye problems and glad that they seem to be on the mend.
Re not taking account of warning signs of mental probems a bit earlier,... well, in a way you and Will Self have covered that. The treatments don't work. There are so many awful quacks around, so many drugs that are of dubious use in many cases. Almost no help for psychological problems. What's the point of spotting warning signs if you can't do anything to improve yourself?
I suppose we should be glad, that we don't live in an age when physical medicine is similarly primitive. The truth is we know very little about how the brain works.

Natalie d'Arbeloff said...

Couldn't agree more with your assessment. And your unanswered question is very important : why haven't alternatives to psychiatry and pharma approaches to mental health really made any improvements? Seems that it's not in the interest of the medical profession to focus attention, research and funds to this question.

Glad your eye is restored to health and that you're back online.

Dominic Rivron said...

Thanks for these comments, everyone.