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.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.