The health professions make a grave mistake when they treat mental illnesses as “discrete brain conditions that are largely genetically determined and barely influenced by the slings and arrows of misfortune,” writes clinical psychologist and researcher Richard Bentall.
VIDEO BELOW: Mental health activist Eleanor Longden discusses the voices she has heard in her head throughout her adult life, where she believes they come from and how she came to live an “exciting, enjoyable life” in spite of them.
“According to this view,” Bentall continues, “psychiatric conditions occur largely out of the blue in individuals who are genetically vulnerable, are uncontrollable and lifelong conditions, and the only appropriate response is therefore to find the right medication. This approach is not supported by recent research, which tells a more complex story.”
Recent studies have pointed to a wide range of social and environmental factors that increase the risk of mental ill health. These include poverty in childhood, social inequality and early exposure to urban environments; migration and belonging to an ethnic minority (all trending in the wrong direction); early separation from parents; childhood sexual, physical and emotional abuse; and bullying in schools.
In an analysis of all the research on childhood trauma and psychosis, my colleagues and I found that exposure to any of these childhood adversities increased the risk of psychosis approximately three-fold, and those who had multiple traumatic experiences were at much higher risk. In fact, the evidence of a link between childhood misfortune and future psychiatric disorder is about as strong statistically as the link between smoking and lung cancer.
There is also now strong evidence that these kinds of experiences affect brain structure, explaining many of the abnormal neuro-imaging findings that have been reported for psychiatric patients. And of course there are myriad adult adversities that also contribute to mental ill health, including debt, unhappy marriages, excessively demanding work environments and the threat of unemployment. Arguably the biggest cause of human misery is miserable relationships with other people, conducted in miserable circumstances. …
Why is all this important? For one thing, many psychiatric patients in Britain feel that services too often ignore their life stories. In the words of Eleanor Longden, a mental health activist, “They always ask what is wrong with you and hardly ever ask what happened to you.” Patients are routinely offered powerful drugs (which clearly have a place but only help some patients), but very rarely the kinds of psychological therapies that may help them come to terms with these kinds of experiences, or even practical advice (debt counselling probably has a place in the treatment of depression, for example).
A narrow medical approach has been extraordinarily unsuccessful, despite what many people assume. Whereas survival and recovery rates for severe physical conditions such as cancer and heart disease have improved dramatically since the second world war, recovery rates for severe mental illness have not shifted at all. Those countries that spend the least on psychiatric services have the best outcomes for severe mental illness, whereas those that spend the most have the highest suicide rates. …
Finally, a narrow biomedical approach entirely neglects the public health dimension. Given the evidence, we should be able to dramatically reduce the prevalence of mental health problems by, for example, addressing childhood poverty and inequality, figuring out which aspects of the urban environment are toxic (not surprisingly, living close to a park appears to provide some protection against mental illness), and by aiming to ensure that all our children experience benign childhoods. Some potential influences on mental health (eg the way we organise our schools) have hardly been studied. We cannot create a mentally healthier world if we spend all our time peering into test tubes.
Bentall’s findings suggest a maxim: policies that are likely to engender misery should neither be legislated by governments nor adopted by institutions.
Read Bentall’s full article here.