Like Dr Sanah Ahsan (I’m a psychologist – and I believe we’ve been told devastating lies about mental health, 6 September), I too work as a clinical psychologist and I see every day the impact of inequality, social injustice and abuse of power on individuals’ mental health (and by association, the mental health of their children, partners, colleagues and acquaintances).
For too long, the dominant narrative locates problems in individuals, medicalises them and leaves people feeling helpless, ill and stigmatised. It is as though they are defective, and not positive and resilient enough. This lie affects people from all walks of life, but most severely those who are already disfranchised through poverty and inequality.
A huge privilege of my job is hearing people’s rich life stories. Depression, anxiety and psychosis all make sense when you take time to understand the context in which they arose. There is nothing pathological about the anxiety and mistrust felt by a young mother who is about to be made homeless. Or depression and shame in a gay man who has endured discrimination for decades. As the British psychiatrist RD Laing reportedly once said: “Insanity [is] a perfectly rational adjustment to an insane world.”
Let’s stop talking about the mental health crisis and start talking about the corrupt and cruel politics in the UK right now. Let’s stop despairing, and see hope in the huge numbers of people in distress. Let’s get angry with the status quo and seek to change it.
Abbie Pearce
Bristol
• Dr Sanah Ahsan’s article is an excellent example of how discourse is used to locate problems in individuals rather than systems. One example is described by Lisa Marin Wexler in work with the Iñupiat community in Alaska. Her aim is to reduce the incidence of young male suicide in the community. Her successful “treatment” is not more therapy, but community-based learning circles to challenge the presentation of the suicide statistics as examples of community dysfunction that had led to despondency and self-blame.
Wexler changed the conversation by fostering community action, resilience and resistance, and reconceptualising colonisation as something that continues in many forms today, so that the Iñupiat can withstand and resist oppressive structures. In this way, local community practices aimed at decolonisation and prevention have become an effective youth suicide prevention strategy.
The lesson is that the more we can help people understand oppression, the more they connect and seek to act together to oppose it, and the more likely they will improve their resilience.
Anna Wright
Woking, Surrey
• I’ve recently qualified as a counsellor and have been volunteering at a charity. I also work full-time in an office for a large bank. Dr Sanah Ahsan’s article has resonated for a number of reasons. First, many clients attend therapy with issues that require a change in circumstances to really fix them. No amount of therapy can make up for not being watered, to use Dr Ahsan’s analogy.
Second, in the bank the emphasis is always on resilience, rather than looking at why employees feel they are not able to cope. Employees are told to go to the employee assistance programme when they are struggling with their mental health, but the working environment is not considered or reviewed. This suggests that while mental health is talked about more, stigma remains, and the desire for an easy fix is a major barrier to improvement.
Name and address supplied
• I work with people who self-harm and often want to die. I strongly identify with Dr Sanah Ahsan’s article around how we label individuals as ill or flawed rather than seeing an adaptation to extreme environmental pressures. Everyone I work with has experienced traumatic neglect, abandonment and abuse from those who should have protected them. We tell the survivors of a lifetime of adversity that their personalities are disordered.
We provide help that doesn’t match National Institute for Health and Care Excellence guidelines, then blame them further when they fail to benefit. In his book Cracked: Why Psychiatry Is Doing More Harm Than Good, James Davies writes of how institutions adapt to serve the ideology of the time rather than the citizens of the country. As the gap between rich and poor widens, as the suicide rate for children grows, it is more convenient to blame an underclass that cannot cope rather than a society that is killing us.
Name and address supplied
• In my 30-year experience with adults and children suffering mental health problems, I’ve seen psychiatrists’ diagnostic manuals mushroom in size and complexity. They keep adding more labels for people’s conditions alongside research identifying chemical imbalances in the brain. The problem is one of cause and effect. Are chemical imbalances an effect of mental illness or a cause?
New research is contesting the chemical origin of mental illness. Dr Sanah Ahsan highlights the link between poverty and mental illness, underlining research revealing the disproportionate numbers in the poorest households who suffer. As the cost of living crisis gets worse, unemployment rises, and cuts to mental health services go deeper, there will soon be a mental health epidemic hitting the most vulnerable the hardest. The last thing we need is a government ideologically set against state intervention to help them.
Steven Walker
Former head of child and adolescent mental health, Anglia Ruskin University
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