Wednesday, 14 August 2013

Wave or Particle

I've been thinking a lot about  an article by Giles Fraser which addressed issues of prescription rates of anti-depressants and ritalin. The article locates misery and depression as part of normal human experience and suggests that there is a reliance on quick fixes through medication rather than accepting and processing the unpleasant and negative aspects of our lives.

I must admit, my gut reaction to this article was not good. I could see that there was an interesting argument lurking in there, but whether through carelessness or editing it seemed to make a stand on evidence that was too weak to support it. It also seemed rather dismissive of severe, ongoing depression.

At the same time I was reading some tweets from Rufus May which challenge the assumption of a medical model of mental distress and also looked at taking a zen approach to mental ill health; accepting, hearing and responding to those parts of ourselves that so inconveniently make their pain known to us. I responded to these ideas more positively than I did to the article. Nonetheless, the approach to medication seemed too negative and the hostility to seeing the distress in a medical framework didn't sit quite right.

So, cards on the table. I have a bit of baggage to declare here. I have a background in psychology, have worked in in-patient psychiatric settings, have trained people in pyscho-social work, have helped develop member led mental health services and have worked in mental health advocacy. I am not an uncritical fan of medication and believe that it can only ever do play a partial role in treatment and recovery. However, I have sometimes seen medication have a profoundly positive  impact on people's experiences.

Oh, and one more card. I have had two major experiences of depression in the past 20 years, with some element of the symptoms of depression close by in the intervening period. I believe that without medication at those car crash periods I would have been incapable of engaging in cognitive work to get myself out of there. Believe me, I knew any number of theories, practices, exercises and other tools to help me deal with what I was going through. Unfortunately at my lowest points it is as if someone has cut the plugs off all those tools and they hang there, within reach but ultimately useless. Medication has allowed me to put the plugs back on.

But what started to challenge me was the question, "Is there any such thing as depression?". Depression both a conversational and a medical term. If depression is merely an unwelcome part of the variety of experience it would seem odd to give it special treatment, to in any way medicalise it. And within that spectrum of "normal experience" why would anyone seek help? Surely in this graduated and everyday use of the word depression you should just deal with it and get on with things.

Well, let's just deal with what normal is. When I first started going to CBT, my therapist asked me how often I have suicidal thoughts. I was confident of the answer to that and pretty pleased, because it had come down a lot in the period since I was first referred. I was pretty sure I was most of the way to well, because I'd managed to bring it down to X per day. The look on her face suggested this was not quite as normal as I then thought. You don't want to know what X equals. You definitely don't want to know X at its worst.

I firmly support the idea that mental health is a spectrum which we walk upon, that there is no "us" and "them". But I also believe that there are categories of experience and levels of distress where people actively need support, and this support is unlikely to fit into the normal category.

On an intellectual level I am interested in the nature and causes of mental distress. Is it biochemical, is it genetic, is it a psychosocial adjustment, is it maladaptive cognitive patterns? Some of these, all, none? When I'm in distress I couldn't care less. Those questions become irrelevant if they don't lead to someone accepting the distress I'm in and helping me to do something about it.

Medical or social, chemical or cognitive, car crash or contiuum? I fear that too often the debate is still polarised. There used to be a debate in physics about whether light was a wave or a particle. Observation, experimentation, analysis and creativity revealed it could display the properties of both. Reconciling the apparent contradiction led to a deeper understanding. Let's hope we can do something similar in the field of mental distress.

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