Updated: Jul 27, 2020
By Kathryn Grassu
I would like to preface this article by unreservedly declaring my overwhelming support for open communication of feelings and mental state from one trusted individual to another. Talking to someone, anyone, about your problems is always a better idea than keeping them to yourself. In addition, everyone is different and people’s coping mechanisms should not be judged and ranked against your own. But something about the way we discuss matters of psychological harm in current times bothers me just a little bit.
The idea that the brain can just get sick, as if with its own kind of flu appeals to people in its blameless imagery and conceptual simplicity but what if medicalizing the spiralling sense of despair we get from being unable to overcome the ghosts of our past isn’t actually helping us live with our emotions in a healthier way? What if thinking of yourself as a sick person in need of drug treatment can be more of a paralytic self-fulfilling prophecy than we realise?
In my own experience of mood and behavioural problems, a cognitive approach would easily pick up on my tendencies towards displaying depressive and anxious ‘symptoms’ which could be treated via slowly changing my attitude towards myself and my daily life, and this is what your bog-standard course of NHS CBT (Cognitive Behavioural Therapy) will strive to do. But in the rush to declare you fit for normal societal duties and getting you back on the capitalist treadmill, the importance of WHY you have these problems, HOW they formed, and even WHY they are an issue at all for yourself or others in your life is almost always overlooked. Traditional psychoanalytic therapy on the other hand, seeks to go deeper into the layers of self we have repressed or forgotten, building a clear picture of how we ended up where we are and how we can go about gradually but permanently changing things for the better. Analysis works off a series of your own realisations interspersed with interpretations offered to you (but not forcefully pressed unlike most CBT) by your therapist who does not take on an authoritative doctor-ly role, but is a companion walking alongside you through your memories, helping us sort through the muddle we pretty much all get into by enduring the slings and arrows of even a perfectly normal childhood. CBT was designed to treat people who have reached a crisis point, often involving compulsive behaviours such as self-harm and OCD. This form of therapy was never supposed to be a catch-all for every flavour of distress, and yet there is NO provision for psychoanalysis on the NHS. None. CBT is pretty much the only approach offered to anyone who dares to seek help. Even if CBT was very effective, having no other option available would be wrong. As it is, the approach is woefully under-equipped to deal with the depth and complexity of the issues faced by many of us struggling to cope. I hardly need to mention that the state of waiting lists for the suicidal are so dire that they cost alarming amounts of lives. Therefore, imagine how hard it must be to get what you need when you haven’t yet reached the level that makes the state take notice. People are being told to go away and come back when their quality of life has further worsened. Everyone deserves better than
I find the attitude of non-psychoanalytic treatment very reductive, people have often reported to me that they are told by doctors that they’re just thinking too negatively about their circumstances and all they really need to change is their attitude, not the conditions in their life. This to me suggests that these practitioners don’t really believe your lifestyle and the people around you can actually damage your sense of self which, evidently, they can; a set of miserable working conditions, bullying colleagues or an emotionally manipulative partner can aggravate our psychic injuries no end. There can be real physical problems that need solving in our life and being told to just face our phobias or think more positively about the future is massively undermining the credibility of our complaints. What if the way society is being run needs to change because of the amount of psychological injury following norms is causing us? How can this possibly get done if we don’t accept that anything outside our attitudes can be a problem?
Another issue I have with the rush to medicalize behaviour is that it marginalises and persecutes those in society whose psychology has evolved to work differently. I have a very high-functioning form of autism, displayed in lesser known typical female autistic traits, and my experience of feeling ostracised by others for having a brain that thinks diagonally is bad enough. The experiences of friends who have been branded with a ‘personality disorder’ or ‘schizophrenia’ because they had a traumatic childhood that affected the way they developed, contained or experienced their emotions is unacceptable. These are perfectly intelligent, functioning individuals who through no fault of their own have evolved a different way of processing the world and thus are treated as though there is something fundamentally wrong with them, and therefore the state should chemically alter their state of mind to fit in better with its systems. A safe, and gradual exploration of their history and the slow repairing of their coping mechanisms and systems for emotional containment would render these people perfectly normal but still entirely individualised and often with no need of chemical intervention. It is because the state does not support the time and effort it takes to properly and permanently address the lives of these people that the problem will always persist. To me this is tragic, of course it costs a lot to keep people well, but it’s importance surely overrides any financial burden.
Moving on to the misery of psychiatric hospitals, the country is lettered with grim Victorian buildings where the sick and unfortunate go to endure state-sanctioned torture. Through a combination of rigid and unnecessary rules designed to frustrate and break the spirit of patients, and a liberal application of physical restraint, forced sedation and a general lack of care and compassion, we (yes, all of us) have failed our mentally ill friends and relatives. Built on an archaic system of ‘moral correction’ (real terminology) and not a far cry from the grim tourism of Bedlam, I have heard direct accounts on how psychiatric hospitalisation as it currently stands in this country MAKES PATIENTS WORSE. You know the whole system is broken when people like you and I spend years deteriorating away with no ability to change the approach of our treatment if it is not working. A dear friend of mine describes her own experience of hospitalization and the over-use of drugs:
"It’s overused. Over-prescribed without a full evaluation of the individual. And that’s if the medication is worth both the long and short-term side effects. Doctors are treating all patients on a one-size-fits-all basis; fluoxetine for the mood, olanzapine for the anxiety, and whatever the cheapest available PRN is. Weekly blood tests and ECG’s because my medication was causing more damage to my body than the ‘disease’ in my head. Medications are just cheaper than Psychoanalytic therapists by the hour. Even if the work with a therapist is harrowing and soul-wrenching, at least you’d know why you feel a certain way. You can pin-point a moment in your life where something changed. 8 pills in the morning doesn’t even allow for accidental revelations of truth. You can’t put a plaster over a bullet wound and expect in a while it’ll be fine on its own. The second you pull the plaster off and discharge the patient the wound does not go away. And it is something that really needs to be faced more than before the plaster went on."
Ultimately, we need to be more realistic with ourselves about how our psychology really works. There are NO quick fixes for our trauma and ego injuries, we cannot just take antibiotics for our brain cold and then wonder why the problem never really goes away. We need to be spreading the word that resolving psychological issues takes years, we should be sharing our progress and struggle towards freeing ourselves of the barriers to our happiness openly. There should be no shame in seeing an analyst and a provision for voluntary free therapy should be the basis of our NHS approach as it is with other health matters. Mandatory or court ordered therapy and a proper community care facility should replace our prison-like hospitals. The more integrated into society we keep those who are struggling, the easier it is to keep stigma levels low and uptake for preventative reasons high.