Good evening! This week's edition of the In Common newsletter comes from Robin McAlpine, head of strategic development at Common Weal
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HAS anything done more damage to good policy than culture wars?
If two sides (and it is two sides) engage with each other not in pursuit of a solution but with the goal of defending their territory then the exchange will devolve into slogans and bad-faith claims. It affects everything, from gender to climate change to vaccines. This week; mental health.
I can't do this issue justice in the space available but I want to show that neither side of the noisy part of this debate is helping anyone. It begins with a loose comment from the UK health minister justifying cuts to disability benefits by claiming mental health problems are over-diagnosed. This is met with fury by people for whom mental health and neurodivergence has become an ideological cultural issue. In Scotland the politicians say they are simply following the science.
There is much to unpack here. First of all you need to differentiate between "over-diagnosis" and "medicalisation". It is absolutely correct that much of what we now accept as mental health issues are not medical at all, and they're not an illness. They are a successful and rational response the brain has made to a harmful environment.
If you are living in poverty or are beset by crime in your community or you have major relationship issues or all sorts of other external stressors, feelings like anxiety or fear or panic or deep despondency are actually healthy reactions. They are the brain recognising that the body is under great stress in some way and these responses are an evolutionary coping mechanism being pushed too far.
It is perfectly legitimate to use medical interventions when there are acute symptoms and that is when we use various drugs such as anti-anxiety medications. But because the problem isn't medical, the solution isn't medical; these are short-term coping measures until something more effective and lasting is put in place.
Parking people on drugs long-term for environmentally-related mental health issues is a disaster (this does not apply to non-environmentally-related issues like schizophrenia or bipolar disorder which do have a medical component). It doesn't work, it just puts people in a permanent holding pattern.
That's why simply saying "follow the science" isn't a sufficient response. Environmentally driven mental health issues aren't diagnosed in the way you think of a medical condition being diagnosed. There is no measurable "cause", no virus or tissue trauma. What you are doing is saying "we're going to take this set of behavioural patterns that we see clustered together and give them a collective name".
Diagnosing is therefore a circular process. If you define lower-than-average attention span as a "symptom" and name it as part of an ADHD diagnosis, then when you find a lower-than-average attention span it is "correct" to "diagnose" it as ADHD.
This is precisely the same mechanism that led to homosexuality being defined as a mental illness for decades. If you define same-sex attraction as an abnormal behaviour then when someone is same-sex attracted they become abnormal.
This is where there genuinely is a risk of over-diagnosis. If we take every-day behaviours or just certain personality types and we define them as "symptoms", we may not be so much diagnosing a condition as creating one from scratch. Having some or even all of the symptoms of say ADHD does not mean you "have something", just that you feel these things.
That doesn't mean that form of diagnosis isn't helpful. It is, it is an effective description of what a person is feeling. If describing it helps provide people with ways of coping with it or leads to therapeutic support or helps people understand what is going on with them, that can be really helpful.
On the other hand it can also be counterproductive. If your fundamental personality falls close to a category that has been defined as a mental health issues, diagnosing it won't necessarily help you. There is a lot of evidence that suggests telling people that "here you go, you've got this thing and that's why you feel like you feel" can make them feel a short-term rush of "feeling understood" followed by a return to the exact same baseline position – or worse.
And yet people sometimes cling to their "diagnosis" in unhealthy ways given that there is no "solution" or "cure", probably doing more to reinforce and build on the problem than help resolve it. Plus of course there is a big and lucrative 'mental health industry' which benefits from persuading you that there is something wrong with you ... and that they have the solution.
There is so, so much more to say about this. The feelings people have when they say they have mental health issues are very real indeed. The solution could be medical (treatment for bipolar disorder), it could be environmental (supporting people in severe financial distress with debt reduction programmes), it could be talking therapy (helping people deal with an process difficult events in their past), it could be coping methods (mindfulness or Cognitive Behavioural Therapy).
These all cost money in the short term and that is why politicians like either to medicalise this and just put people on a drugs regime (comparatively inexpensive until it mounts up) or blame the "snowflakes" (which is simply wrong). More often than not mental health is a care issue not a medical issue, but our care services are in chaos.
Common Weal set out a genuinely inspiring vision of how we could take a serious approach to this issue via a well-designed National Care Service. Unfortunately the Scottish Government botched that and we are where we are. But the solution to this is neither to shout "believe everyone and give them the drugs they want" or "tell them they're weak and need to buck up".
Yet between these stupidities is where we're stuck, and no-one in power is offering or proposing a way out. Not least because of the stupid bloody culture wars ...
