—Who is really sick—
the individual, or society?
by Emma Svanberg
“It is not always easy for people in emotional turmoil to shift their attention from self to world, and yet, if they are to gain an understanding of the origins of their difficulties, that is the most important thing for them to do. We have learned, when in physical pain, to look for the cause inside our bodies, and perhaps that is why we tend to think that the roots of ‘psychological’ pain are to be found inside our minds. However, when it comes to understanding so-called clinical distress, the causes of our pain are likely to be found in the world beyond our skin.”
David Smail, ‘How to Survive without Psychotherapy’,
Being a psychologist is a funny old job. Much of my day is spent sitting in a room and chatting to people - or perhaps more often sitting and listening to people. I know that often people do find those conversations helpful. Being an outsider means you’re able to spot patterns that you couldn’t if you knew someone well. Not being a friend means you can ask challenging questions. And of course having the benefit of different theories, and having spoken to many other people in that room, means you have a guide to helping someone understand what they are going through.
At least once a month I have a moment when I wonder really, is what I am doing actually helpful? Is therapy actually helpful? Because what we do when we sit and talk about someone’s difficulties is, implicitly, make it into their problem. And yet, much of the time, those problems are caused by wider issues. Issues to do with family history, with deprivation, with environment, with societal pressures or norms. And perhaps, yes, we can work through those problems together and ease their burden in some way.
But I often wonder - by continuing to see individuals - am I contributing to the myth that problems are caused and solved by individuals? When actually societal shift is what will solve those problems.
When we ask about diagnosable mental health conditions, the usual stat is that mental health problems affect one in four of us. But when we start to look at distress, stress and overwhelm (terms that perhaps have much less stigma attached to them), figures become much higher. A Mental Health Foundation survey carried out earlier this year found that 74% of respondents felt so overwhelmed in the previous year, they felt they couldn’t cope. My area of work is in the perinatal period - from pregnancy through to the early years of parenthood. Most research suggests that 10-15% of women will experience postnatal depression or anxiety. Yet the NCT Hidden Half campaign found that 50% of respondents had struggled with their emotional health. And we know mental health problems are on the increase – a MIND study this year found that GPs have noticed that more of their patients are coming to see them with mental health concerns. This may be due to a greater awareness, but it may also be that we are becoming increasingly mentally unhealthy.
It doesn’t take a psychologist to wonder if society is affecting our sanity. When so many people are struggling with their mental health, then it becomes the norm not the exception, and we have to wonder what we are doing to cause this epidemic. Matt Haig, in his brilliant book ‘Notes from a Nervous Planet’ writes ‘couldn’t aspects of how we live in the modern world be responsible for how we feel in the modern world?’
And as well as life having become more isolated, more technologically driven, more open to comparison, it’s also got, well, harder. Yes taking a social media break is helpful. But it’s not as helpful as having enough income to know that you can provide for your family, or knowing that your employment is stable. We know that mental health problems have grown worse under austerity (and despite promises of financial boost, these will be nowhere near adequate to turn things around).
We also know that, when you are brave enough to ask for support there’s a good chance you won’t be seen by anyone, and if you are it is likely to be a short term intervention. Mental health funding has been cut and become so target-driven that psychologists, depressed themselves, are leaving the NHS in droves. Working as I used to in primary care, I often wondered how it felt to be referred to a psychologist when actually what you had was inadequate housing, or a letter telling you that the benefits you’ve relied on for your adult life have been cut because you were too anxious to attend your assessment. Or, worse, that you did attend your assessment and your lifelong problems were completely ignored.
Policies such as Universal Credit have left people poorer than ever, and feeling completely disenfranchised, yet unable to question for fear of their position worsening. My fellow psychologist Jay Watts writes and speaks about this far more eloquently here.
Working predominantly with parents as I do, the same themes emerge time and time again – of overwhelm, of loneliness, of frustration.
Yet how can parenting in total isolation, as we often do nowadays, not have an impact on our mental health? It’s no surprise that in countries where women are given a period of rest and help from family members after birth, there are lower rates of post-natal depression (particularly when that help meets the woman’s individual needs).
We know that stress is linked to feeling under threat, and the greater the inequality we face as a society, the more stressed out we will become. And a vicious cycle ensues when we then diagnose people with a mental illness for reacting exactly as they should – as if they are under threat. Freud described depression as anger turned inwards, and I wonder if – as a society – we have become depressed because our anger hasn’t got us very far.
So I continue to do the job I do, and sit with people in their distress. And sometimes I can help people untangle the things which brought them to me. But sometimes I help people find the services they really need (that have often sprung up in the voluntary sector by people determined to fill gaps in services as they disappear). And sometimes my job is just to, in Irvin Yalom’s words, travel with people on their journey - always my greatest privilege.