I was at a televised event recently during which a documentary about mental health problems — part of the BBC’s largely execrable All in The Mind strand — received two prestigious awards. The producer of the documentary made a gracious acceptance speech during which the old trope about battling the stigma associated with these ‘terrible diseases’ was trotted out, as was the ubiquitous (and, ironically, stigmatising) ‘1 in 4’ figure. The subject of the documentary — a TV celebrity who had worked his way through a gruelling bout of depression — also took the stage. In a clip from his film he likened his use of psychoactive drugs to taking “A cool drink of water after a drought.”
I put my head in my hands at that point, not because I dispute his personal narrative — he is the expert in his own experience and the important thing is that he feels better — but because that line is so memorable. It is a lyrical distillation of all the pharmaceutical industry would like us to believe. Had I been the manufacturer of his medication I would have put it on my product the next day and waited for sales to soar! But my frustration was also due to the fact that, once again, a reductive, medically-driven view of mental health problems was being given a public platform and the people watching were being misinformed – if not by design then by omission.
Thus I ended 2016 as I started it: listening to a celebrity reducing the complex interplay between society and the psyche to a matter of simple biology. The celebrity I encountered earlier in 2016 is a much more powerful figure in the world of mental health: Ruby Wax.
I have been aware of Ruby Wax for a long time. She is a difficult person to ignore. This ferocious American virago first entered my consciousness in the early Eighties, in TV shows such as Girls on Top. Later, in the Ruby Wax Meets series, she proved herself to be an overly-familiar but highly effective interviewer, teasing revelations and reactions out of a wide-range of startled celebrities such as Madonna, Imelda Marcos and Donald Trump. More recently, she has evolved into an influential mental health campaigner and lecturer — and has received an OBE (an honour bestowed by the Queen) for her efforts.
Mental health is a complex field within which there is room for a range of voices. Ruby Wax is as well-qualified to contribute towards it as anyone else. In fact, she has what I consider to be the best qualification to work in mental health: personal experience. She is very candid about her prolonged and painful bouts of depression. Her extensive personal experience has been strengthened by academic insight. She has a Master’s degree in mindfulness-based cognitive behaviour therapy from Oxford University. Consequently, whenever our media focuses its butterfly mind upon the subject of mental health, before flitting on to more colourful and less complex matters, Ruby Wax is sought out. No mental health crisis is complete without a quote from her.
If you are interested in what Ruby Wax thinks about mental health, the best way to find out (short of reading her two books on the subject) is to attend her stage show, Frazzled: A Guide To Mindfulness, which is still touring the UK. I took the opportunity to see the show when it was in London, last February. As a mental health professional I thought I might learn something from it. I was not wrong.
It is not a long show — roughly an hour of performance before a short break followed by a Q&A session with the audience — nor is it limited to the subject of mental health alone. Ms Wax starts by speaking about the nadir of her TV career: her 2005 appearance in a show called Celebrity Shark Bait, a programme every bit as contrived and exploitative as it sounds. Four celebrities in various stages of career desperation went through a short acclimatization process before cage diving with Great Whites in South Africa. The reviews were not kind. The Manchester Evening News was moved to report: “Any show where there’s a chance that Ruby Wax might get eaten alive can’t be all bad.” Charming.
After this brief career retrospective, Frazzled moved on to more serious subject matter: namely neuroscience. This bit was nicely done. Ms Wax focused upon anxiety and how this natural threat response becomes problematic when it is overstimulated by the serial stresses of the modern world, which she considers to be too much for our primitive brains — in particular, the amygdala — to cope with. Anxiety is a significant social and economic issue. In America alone, over 40 million adults are described as having some kind of anxiety related disorder — a quite staggering figure with costly implications, in both human and monetary terms. No wonder mindfulness, a practice which can be used to pacify and focus turbulent minds, has become an assumed panacea, as well as a boon to Ms Wax herself.
As we know, the ‘fight or flight’ response triggers the release of chemicals that sharpen our defences, such as the hormone cortisol. Ms Wax is keen on chemicals as both causal and curative agents. At one point in her performance she described herself as a “cortisol person” — someone defined by an abundance of this essential but potentially damaging chemical. Of course, to some extent we are all chemical creatures. There are approximately sixty of them sloshing around our systems, though we are mainly composed of oxygen, carbon, hydrogen and nitrogen. Nonetheless, defining oneself by a surfeit of a single chemical agent seems a curiously reductive approach to mental health — and to humanity itself.
Then we reached the Q&A. This was when Ms Wax’s reductive approach to mental health became even more apparent. During this segment, one audience member described herself as being “One of the 1 in 4 — and proud of it.” It takes courage to disclose a mental health problem in a public forum. I admire the person concerned for doing so. What jarred me was the fact that the ‘1 in 4’ idea went unchallenged. This statistic has taken on hallowed status in our society. It is uttered reverently like a sacred truth, whenever someone (usually a politician) wants to demonstrate their sensitivity on the subject of mental health. Yet there is no ‘one in four’ in any meaningful sense, and perpetuating the idea that there is can be dangerous.
For one thing, it creates the impression that twenty-five percent of people have some special susceptibility to ‘mental illness’ — which is both unproven and a powerful source of stigma in itself. For another, it creates the equally damaging impression that seventy-five percent of people are off the hook. Nothing could be further from the truth. If you were to take any sane, secure and accomplished member of society and subject that person to inhumane treatment for long enough — inflicting loss after loss upon them — you would produce in them the so-called symptoms of anxiety, depression and possibly even psychosis. Opponents of the social determinants school would argue that such treatment would only be triggering peoples’ underlying susceptibility to mental disorders. To which I would reply: someone, or something, still needs to pull the trigger.
Further concern was raised by Ms Wax’s response to another audience member. She too was a courageous woman. She confessed that she and her husband were in the midst of serious financial difficulties — so severe that they had been visited by bailiffs during Christmas. Naturally the poor woman was depressed about this fact. Anyone who has experienced financial difficulties would be able to sympathise. But Ms Wax’s response to this troubled woman was worrying. She identified her, from only the look in her eyes, as being one of “My people” — i.e. the ‘mentally ill’ — then told her that, “It’s a disease,” “Your body needs chemicals” and that she should go to her doctor and insist upon getting “The good stuff.”
These lines got the loudest round of applause all evening, suggesting that hundreds of people were going to leave the theatre thinking that they had been given good advice. I am certain that Ms Wax is motivated by a desire to reduce human suffering, but I fail to see how a prescription for antidepressants is going to solve anyone’s financial problems — or resolve any of life’s other painful and frequent misfortunes. That is assuming, of course, that antidepressants have any positive impact beyond the placebo effect of knowingly taking them; and that they don’t have distressing side effects.
Ruby Wax may be big on chemicals, but she is less keen on context. True, she acknowledges the anxiety-inducing impact of our increasing frenetic world, but that is where her interest in the external ends. Instead, she hammers home the message that ‘mental illness’ is due to ‘broken brains’ and the way forward is brain research, rather than more humane social policy.
Nor does she seem overly reflective. Putting her depression to one side for a moment, does she ever wonder where her desire to perform comes from? Why does she seek the applause, the validation, even the love of an audience? Is this due to some thespian gene she possesses? Is it the result of another chemical deficiency in her ‘broken brain’? Or is there some unmet emotional need deeply rooted in her distant past? If so (and I have no way of knowing), she would not be the first woman with a ‘mental illness’ to take solace in art. Marilyn Monroe, Sylvia Plath, Virginia Woolf and Judy Garland all turned the trauma of their formative years into performance — which was very fortunate for us, if not for them.
One of the main drawbacks of the disease paradigm, peddled by the likes of Ruby Wax — other than the fact that it deprives people of the opportunity to really understand their suffering and find meaning in it — is that it undermines the case for prevention. Throughout medical history, prevention and cure have often gone hand in hand. The identification of the cholera bacillus, for example, demonstrated the importance of a clean water supply and good public sanitation, as well as providing the basis for an effective vaccine. Yet in mental health the link between prevention and cure has been severed. The importance of the social determinants of mental health is often minimised or denied.
Instead, old and discredited medical ideas such as humoral theory and spontaneous generation have resurfaced under new names. Yet people drink daily from deadly psychological sewers — through which flow a foul cocktail of abuse, neglect, exclusion, poverty, discrimination, inequality and conflict — and we pretend that it has no impact upon them, other than to trigger their so-called ‘diseases’.
As I staggered out of the theatre, after witnessing Ms Wax’s performance, I was troubled both by the misinformation that had been imposed on the audience and by the disturbingly ‘evangelical’ atmosphere produced by the peddling of these biological myths. It felt as difficult to disagree as to stand up during a church service and confess to atheism.
It shouldn’t be. Some of the world’s leading psychiatrists have confirmed that there are no ‘biomarkers’ proving biological causes for depression, or any other mental health problem. To repeat, I am sure that Ruby Wax is acting in good faith. However, her information is not just reductive, but potentially damaging. It could encourage people to accept stigmatising diagnostic labels, false ideas of disablement and a lifetime on prescription drugs. Is this the kind of campaigning we should be promoting in the media and rewarding with an OBE? Ms Wax was given her award for services to mental health; it might have been better to grant it for her support to the pharmaceutical industry, for which she is such an effective spokesperson.
If 2016 taught us nothing else, it showed us that the reductive is seductive. In the face of a complex, fast-paced and often threatening world, people seek comfort in easy explanations and quick fixes. Nowhere is this more evident than in the field of mental health, where diagnostic psychiatry offers an account of mental health problems that simplifies complex phenomena and absolves everyone of responsibility: politicians for the psychological consequences of their policies, members of the public for the impact of their actions upon the mental health of others, and people with mental health problems for the painful and difficult task of improving their lives.
Diagnostic psychiatry is a work of expedient genius. It provides the illusion of science and certainty beneath the symbolic purity of the MD’s white coat. But genius is not a moral quality and it is not always right. When it comes to understanding mental health problems, only a Theory of Everything will do: encompassing the spirit, society, psychology, emotions and, yes, the body as well. The task is too important to rest with a single profession, be that psychiatry, psychology or neuroscience. And it is far too important to be left to celebrities — even those with good intentions and personal experience of mental health problems.
http://blogs.discovermagazine.com/neuroskeptic/2017/01/14/fmri-mental-illness/#.WHt2EFzRMk4
‘A remarkable and troubling new paper…Sprooten et al.’s analysis included 537 studies with a total of 21,427 participants. Five mental illnesses were examined: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, and obsessive compulsive disorder (OCD)…
…The results were rather surprising. It turned out that there were very few differences between the different disorders in terms of the distribution of the group differences across the brain…In other words, there was little or no diagnostic specificity in the fMRI results…
…Sprooten et al. suggest that “the disorders examined here arise from largely overlapping neural network dysfunction”, in other words that the transdiagnostic trait is a neurobiological part of the cause of the various different disorders. But it seems to me that there’s no reason to assume this.
What if the common factor is more straightforward: something like anxiety or stress during the MRI scan?’
Insightful piece, Paul, thank you. I think this is an important point, “in mental health the link between prevention and cure has been severed. The importance of the social determinants of mental health is often minimised or denied.”
My situation is a perfect example of this, although the medical evidence is also in showing my situation is quite typical. I was drugged by doctors who wanted to profiteer off of covering up easily recognized iatrogenesis and medical evidence of the sexual abuse of my small child. But once the medical records with the evidence of the child abuse and paranoia of my PCP were finally handed over, it was a relief to me, despite it being appalling news. Because it allowed me to understand the motives of the despicable doctors who DSM defamed and poisoned me, thus medical denial of real life appalling crimes was no longer an option for these deplorable doctors.
Understanding “the social determinants of mental health is” key to healing. And profiteering off of denying child abuse does seem to be the number one actual function of today’s psychiatric industry given, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”
I definitely agree, “When it comes to understanding mental health problems, only a Theory of Everything will do: encompassing the spirit, society, psychology, emotions and, yes, the body as well.” Don’t forget potential financial and/or other criminal motives of the medical community either. “The task is too important to rest with a single profession, be that psychiatry, psychology or neuroscience,” especially given the unseemly historic, and current, tract record of these child abuse denying and covering up professions.
But rumor on the internet is that Washington DC is crawling with pedophiles, so this does explain why our current government officials are pushing and advocating belief in the scientifically invalid DSM theories of today’s pedophile denying psychiatric and psychological industries. Let’s pray for real change, and change for the better.
Very well-written paper, Paul.
I had not even heard of Ruby Wax before. To my knowledge her popularity has not reached America. However I don’t watch TV, so my ignorance could be my own disconnection from popular media.
I don’t think it’s difficult to disagree with biological reductionism. I regularly do so in all sorts of public settings. For instance, at a meetup event recently, I directed refuted the idea that “schizophrenics” always have to take drugs. People were shocked; I didn’t care.
I am not sure why you stooped to this part:
“Opponents of the social determinants school would argue that such treatment would only be triggering peoples’ underlying susceptibility to mental disorders. To which I would reply: someone, or something, still needs to pull the trigger.”
It appeared that you agreed that there is a “trigger” to supposed vulnerability; I think this is problematic. The human genome did not evolve to reify DSM or ICD diagnoses. The most we can speculate is that some people might be genetically more or less resistant to stress, with the way they react to it being highly individualized, not more or less resistant to to invalid creations of the white-coat people. The research on genetics and mental labels has produced nothing of note. Besides, once a person is born, their epigenome and biology is constantly being modified by interaction with the environment in an interpenetrating process. Genetic vulnerability to stress is not some static thing that stays the same throughout life.
Paul, You might consider Mary Boyle’s thinking on “vulnerability-stress” theory:
Quote: “Who or what is protected from scrutiny by vulnerability?
In the case of vulnerability-stress theory, thefocus of scrutiny has been the ‘vulnerable’ indi- vidual – whatever else they’re protected from,it’s not our scrutiny. This focus is made to seemreasonable partly through word order: the the-ory is stated as ‘vulnerability-stress’ with the im-plication that vulnerability comes first, is morebasic, so that it seems reasonable to focus on theperson to identify the nature of this vulnerability and perhaps to put it right. Even when vulnera-bility is used more generally, the focus is stillmainly on the vulnerable person, a focus whichseems reasonable at least partly because of psy-chology’s and psychiatry’s claims to have discov-ered many negative individual attributes –low-self-esteem, cognitive deficits, mental disor-ders etc, which not only seem to explain the vul-nerability but make it easy for us to accept vulnerability as yet another attribute – a state-ment about a person – rather than a relationalstatement about what happens between people. Vulnerability exposes only one side of this rela-tionship, while protecting the other fromscrutiny. We can see this relational aspect clearly if we take statements about individual vulnera-bility and ‘translate’ them into statements aboutrelationships. On the left side of Table 1 are state-ments of a sort easily found in the media and pro-fessional literature, apparently about individuals,or social groups, and which suggest that our focusshould be on these people or groups – how toprotect them, make them more resilient, and soon. But if these statements are translated intorelational statements (with the two referencedexceptions, not found in the media or literature)
then a very different picture emerges in which twopoints are worth noting. First, that the reasonable-seeming focus of our scrutiny and potential actionis changed from the vulnerable individual to those who seem to be damaging them. Second, in every case, the people or groups who do not appear inthe statements about vulnerability, are in various ways more powerful than their counterparts whodo. The disturbing conclusion is that the idea of vulnerability runs the risk of systematically pro-tecting from scrutiny the potentially damagingactivities of relatively more powerful socialgroups. Since vulnerability is usually named inothers by those in positions of relative power, itis perhaps not surprising that they should wishto protect their privacy. But we should not un-derestimate how helpful psychology and psychi-atry have been to this process, with their persistent focus on the individual and their pro- vision of an extensive range of negative charac-teristics both to explain vulnerability and tofoster its acceptance as an individual attribute.”
Source: page 27 of this download – https://www.academia.edu/532717/I_want_therefore_I_am_A_tribute_to_David_Smail?auto=download
Lastly, it is amazing that people continue to believe the trope about 25% of the population “having mental disorders”. As I like to say, according to psychiatrists here in America 80 million people have clearly diagnosable psychiatric diseases and 240 million are completely normal. When you frame it like that, it’s obviously bullshit. No one is immune from the problems of living, and those problems are matters of degree without clear cutoff points along a continuum.
Paul: Thanks for the heads up. Ruby Wax is coming to our local theatre this week – think I’ll pass. However, you said:
“I am certain that Ms Wax is motivated by a desire to reduce human suffering” and “I am sure that Ruby Wax is acting in good faith.”
Why so sure? Ruby Wax is riding high on this ticket – pulling in a hefty income from all those bums on seats, not to mention the book deals and, of course, a steady supply of that most potent of drugs: attention. I only hope that Stephen Fry and Alistair Campbell don’t get the same idea…
I think it is a pity you are passing on a chance to see Ms Wax.
A few disruptive questions, hisses and boos from the audience would liven up this turgid show.
A banner saying DRUG PUSHER in the lobby of the venue would make look fab in the local press.
Oh, that would be so cool…! But as a timid, solitary creature I’m not sure it’s quite my brand of activism. Nice idea though.
Auntie — Love your work. Are you a different poster than “AntiP” — and do YOU have a public email or secure way of contacting you directly?
Oldhead- Thanks! That means a lot to me. No, I don’t post as AntiP, and yes I do have an e-mail address. You’ll find it on my website on the ‘About Auntie’ page. I’d love to hear from you – I’m always happy to receive e-mails. Here’s the link: http:\www.auntiepsychiatry.com
If Ruby Wax really did say this… “It’s a disease,” “Your body needs chemicals” and that she should go to her doctor and insist upon getting “The good stuff.” – then DRUG PUSHER isn’t far off the mark.
Stephen Fry is pushing nonsense and pseudoscience about “mental illness” for all he’s worth. I don’t know how much money he’s making out of it.
The power of psychiatry lies with its false claim of biological reductionism. It is problematic to imply that psychiatry is biologically reductive since hard science will always be respected by the community more than soft science.
You had it correct in ONLY 5 words….:
“The power of psychiatry LIES….”…..
Me? I’m verbose….I’d’a said,
“The LIES of the pseudoscience drug racket known as “psychiatry”…..
Years ago I read an autobiography by Wax. In it she portrayed her parents as horrid.
That was before she trained as a clinical psychologist and got the mental health bug.
This is what she said in a Guardian interview:
“Fans of Wax will be familiar with her parents. From her earliest days as a comic, they were great source material. Her Jewish parents had fled Austria and Hitler and found safety in the US – her dad became a wealthy sausage manufacturer, her mother a depressive beauty with a fine brain (she spoke nine languages) and a frigid soul. That’s the way she told it, anyway. Her act was fuelled by anger at the parents who dismissed their only child as an ungainly loser.
Wax tells me a story about when the family dog died to illustrate her relationship with her mother. “I was away at school and she went and got a replica of the dog. He was 150 in dog years when he died and when I came home there was a puppy. She didn’t mention he died.”
She sounds a nightmare, I say. “She is a nightmare. Yep.” Wax pauses.”No. Not a nightmare any more. She’s sweet now.” Is she senile? “Senile, yeah.” Wax says that her mother barely recognises her when she visits.”
https://www.theguardian.com/media/2002/mar/25/broadcasting.comment
Here is an interview with Wax on Dutch tv about her parents. Having watched it, why does she or anyone need any genetic explanation for Ms Wax’s depression? https://www.youtube.com/watch?v=0SUmVjG_UWY
Depression can be seen as a belief in the just world fallacy ie that good things happen to good people and that bad things happen to bad people. It is a pity that Wax does not mention this, and how her family history has effected her, in her talks on mental health.
However her talks to confirm that psychiatry has two main functions:
1 to be the drug delivery agent of big pharma
2 to make sure no one asks why someone is distressed
I’ve been familiar with Ruby Wax’s work for decades and she is first and foremost a celebrity and entertainer. Rather like Carrie Fisher she has totally bought into the mainstream psychiatric model of chemical-imbalance induced mental illness and the need for a chemical response. She has gone from opinionated comedy to opinionated chemistry and has found that this new persona really works for her. Sadly her blind belief in her own position is extremely unhelpful to those looking for another path, and to those who understand that the subject is far more complex and that those dealing with any so-called “mental illness” have far more control of their lives than psychiatry and drug companies would have us believe. This pseudo-science model, which we can study in prestigious universities, is very attractive to many people – it makes them feel secure and knowledgeable; in reality it’s dangerous and dis-empowering.
When Prozac came out people said it saved their lives. The placebo effect is really strong.
People also say Jesus saved their lives. https://www.facebook.com/WhatsMyPurpose/
It is called belief or religion.
Hi Paul.
Great Article, I like your sense of humour!
If Ruby Wax has a degree in Mindfulness based Psychotherapy I can’t understand why she doesn’t use this training to help her deal with her Grief.
In my experience anxiety is a type of socially created activity and Buddhist Philosophy and Practice (Mindfulness) can help a person to get beyond the subjectivity of this. This approach has certainly worked for me.
I have never found “medication” to be a cool drink in a desert. I found the “drugs” to be the same as how Psychologist Richard Bentall (LINK, below) found them to be –
https://www.yumpu.com/en/document/view/27908636/richard-bentall-goes-mad-dr-david-healy
I came off strong “medications” in Ireland in 1984 to make Longterm Recovery.
In 1986 my Psychiatrist asked me, how I had managed to get better. I told him that the “medications” had caused my longterm Disability and my Suicidal Episodes, and that my Recovery had been due to stopping them.
The next time I saw my Psychiatrist he told me he was going on a Sabbatical to Canada. He went to Ontario.
“I’m one of the 1 in 4–and proud of it!” I’d call that a stark contrast to the slogan, and button proposal, that Ted Chabasinski came up with awhile back, ‘Anti-Psychiaty–and proud of it!’ For a minority position, it’s pretty bizarre. If 25 % of the population are nutz, given medicalization, that’s something to be proud of now? For my part, I’d like to see a mass mailing, according to the stats, etc., if you happen to be one of the 25 %, give or take a percentage or two, GET WELL SOON! Our nation could sure use the lost GNP.
I would say why are 1 in 4 crazy? How bad is the environment (pollution from what we see, hear and smell)? Why is the work-week so long? How bad are peoples jobs?
This is sad, what I don’t get if she has a masters in mindfulness based CBT why she thinks the chemical balance is still a part of it. Mindfulness CBT has been my learning that has set me free from depressive thinking and a huge part of being well, and is a much better treatment for mental distress than any “medications” are.
Like Matt, I had never heard about her, but when I Googled Ruby Wax I found that she is coming to a local “trendy venue” to do her show.
And will therefore set a biological wave in my community – as it is, my ideas about drugs are considered quite mad, and I’m surrounded by people on drugs. Her stone dropping in my pond can’t be a good thing.