Professor Simon Wessely, who was recently installed as President of Britain’s Royal College of Psychiatrists, has just written his second post in that capacity. It’s called Happiness: The greatest gift that I possess?
The background to Dr. Wessely’s article is the recent launching of the UK’s Centre Forum’s Mental Health Commission’s report: The pursuit of happiness: a new ambition for our mental health. This is a very interesting report, the gist of which can perhaps be gained from these quotes:
“The pursuit of happiness should be a goal of government.”
“Mental health problems are the biggest contributor to poor wellbeing.”
“The national curriculum should include the requirement to teach children and young people how to look after their mental health and build emotional resilience through approaches such as mindfulness.”
“A dedicated mental health minister in the Department of Health should be created with responsibility for mental health services and a Cabinet level Minister for Wellbeing reporting to the Prime Minister should be appointed.”
“Every Health and Wellbeing Board (HWB) should appoint a Wellbeing Champion to advocate parity of esteem between mental and physical health and promote wellbeing.”
“Good mental health and wellbeing policy is simply good health policy, and investment in this new ambition would do more to reduce the human and financial costs of misery and mental health problems. Investment in this ambition could work towards the following achievements:
- Reduce poverty and social disadvantage;
- Promote human rights and inclusion;
- Reduce the human impact of mental health problems;
- Prevent premature death;
- Reduce the economic costs to society;
- Put knowledge of cost-effective treatments into practice.”
The report is interesting in that it appears to be trying to walk a line between psychiatry’s standard cry for more treatment for “mentally ill” individuals on the one hand, and the development of more general strategies for alleviating inequality, promoting competence etc., on the other. The term “mental illness” occurs 19 times; while the term “mental health problem” occurs 91 times. I may be over-reading this, but I did get the impression that the Commission is endorsing the illness doctrine with regards to the conditions labeled schizophrenia, bipolar disorder, and major depression, but rejecting, or at least not endorsing, the doctrine with regards to the other psychiatric “diagnoses.”
In any event, they are recommending that efforts to alleviate mental health problems be expanded to include methods other than psychiatric drugs, electric shock, etc….
Dr. Wessely’s reaction to all of this was interesting.
“At the same time public mental health is also being included in a wider social issue – the current debate loosely around what we might call the ‘wellbeing agenda’. Few people, and probably no members of this College, can, or will, deny the importance of strong communities, families and relationships, to name but three, to our general sense of well being. But in my opinion we need to be a little more cautious about mixing public mental health with this ‘dash for happiness’ – and its various facets such as positive psychology, well being and optimism.”
But his enthusiasm is not total.
“But as an academic psychiatrist with a major interest in population approaches, I am not yet convinced that this will do something significant about reducing the burden of morbidity that we deal with – for example disorders ranging from major depression, phobic disorders, OCD, autism, schizophrenia and so on and so forth. The evidence for this is slender…”
In other words, public promotion of happiness and wellbeing won’t alleviate psychiatric illness. Only psychiatrists can do that.
“Ideally we could do both. Support what we traditionally do, and what our patients expect from us, whilst at the same time also lending our support to the broader agendas that are now being looked at by all three political parties. Unfortunately as we all know ‘there is no more money’. And my worry is that the money for the experimental interventions, which is what they are, will come from our own budgets. I have noticed that is often the case – something that is new, buzzy, smart and promises much tends to be more attractive precisely because it is innovative, and will take resources from what is seen as ‘conventional’.”
On the one hand, Dr. Wessely points out that there is little evidence for the efficacy of the happiness/wellbeing agenda, but ignores the fact that the evidence for the efficacy of psychiatric treatment is based almost entirely on short-term, interest-conflicted, pharma-funded trials. He also seems to have forgotten that it isn’t all that long ago that psychiatric drug treatment was “new, buzzy, smart,” and promised much, and incidentally, hasn’t lived up to its promises.
“…you can come at this from the other direction i.e. that by treating their mental illness, patients will inevitably become happier as their suffering is alleviated. And I certainly can’t argue with that.”
The word “inevitably” strikes me as grandiose. What of the people who have been so damaged by SSRI’s that they are virtually incapable of feeling normal joy? What of those people whose lives have been destroyed by neuroleptic-induced tardive dyskinesia and akathisia? What of the people whose lives have been ruined by benzodiazepine withdrawals? What of the victims of electric shock treatment who can’t remember that they went to college and got a degree? The notion that “psychiatric treatment of mental illness” will inevitably make people happier is the very height of psychiatric arrogance. In my experience, the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment and stigmatization.
“So if we have to make choices, we should remain on the side of patients, carers and the evidence. It’s a difficult balancing act, one that confronts all the three main political parties as they prepare their health manifestos. In the meantime, let’s pursue happiness, but equally let’s not expect that happiness alone will deal with the problem of mental disorder.”
There it is again: this happiness stuff is peripheral; our “patients” are sick, and they need us psychiatrists to “treat” them. It’s the same old song.
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Early in the article, Dr. Wessely stresses the magnitude of the “mental disorder” problem.
“Mental health is an important public health issue…since mental disorder is responsible for an astonishing 23.6% of the years lost to disability in the UK – the second largest cause behind musculoskeletal disorders…. Such a large burden of mental disorder is due to a combination of high prevalence, early onset in the life course, and broad range of impacts including in public health related areas. These impacts result in an annual cost to the English economy alone of £105 billion…and, looking further afield, annual global costs of US$2.5 trillion…and €532.2 billion in the European Union…. Vastly more importantly, this represents a wealth of human suffering.”
Psychiatrists and psychiatric associations have been quoting these kinds of statistics increasingly in recent years, and tragically they are being picked up and promoted unquestioningly by politicians and by the media. But let’s take a closer look:
“…mental disorder is responsible for an astonishing 23.6% of the years lost to disability in the UK…”
In this context, depression is often cited as one of the “illnesses” that contributes to occupational absenteeism. And depression, of course, is a fact of life. We all have our ups and downs. But psychiatrists insist that what they mean by major depression, dysthymia, etc., is not the ordinary ups and downs – but depression-the-illness, which they contend is something radically different.
So the question naturally rises, how do we distinguish between ordinary feeling down, on the one hand, and depression-the-illness on the other. Psychiatry’s answer is that depression-the-illness causes “…clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
This phrase occurs as a criterion feature in almost all psychiatric “diagnoses,” and is embodied in the DSM definition of a mental disorder, but is unsatisfactory from a number of aspects. Firstly, the term “clinically” has no meaning, other than a thinly-veiled attempt to lend a medical flavor to the phrase. Secondly, the term “significant” is not defined, and inevitably rests on the subjective opinion of a psychiatrist, who, in many cases, has a vested interest in “finding” a “diagnosis.” Thirdly, the term “impairment” suggests an inability of the individual to engage in the activity in question, when in fact, the only information that is usually to hand is that the individual hasn’t actually engaged in the activity. Fourthly, the phrase asserts that the causal sequence runs from the “disorder” to the activity (the depression, for instance, causes the person to miss work), when in fact the opposite sequence is just as plausible (missing work causes depression).
But with regards to Dr. Wessely’s statement, there’s an even more serious problem. At any given time, a certain percentage of the population will be experiencing some measure of depression. (Even this isn’t quite accurate, in that depression-joy is a continuum with no sharp cut-offs; but let’s set that consideration aside.) Let’s say that the proportion of people experiencing depression is 10%.
According to psychiatry, a sub-group of these individuals have depression-the-illness. The criterion by which a person gets from the first group to the second group is the clinically-significant-distress-or-impairment standard cited above. One way – and I suggest the major way – of meeting this standard is absence from work. So, a person who is depressed, according to psychiatry, is not necessarily mentally ill, but if he’s depressed and missing work, then he crosses the threshold, and is mentally ill.
So, psychiatry posits absence from work as one of the major criteria for mental illness, and then “discovers” the astonishing fact that mental illness causes (“is responsible for”) a great deal of work absenteeism!
But Dr. Wessely takes the nonsense further. Not only is he blind to his own circular reasoning, he actually goes on to tell us why mental disorders impose such a burden of economic loss and human suffering.
“Such a large burden of mental disorder is due to a combination of high prevalence, early onset in the life course, and broad range of impacts including in public health related areas.” [Emphasis added]
It is not because of high prevalence, early onset, and broad range of impacts that the so-called mental disorders constitute such an economic burden. Rather, it is because of the way psychiatry defines them. When psychiatrists assert that depression-the-illness causes a great deal of missed work, the essential meaning of this statement is that workplace absenteeism is caused by people missing work. This is not quantum physics. It is logic 101.
Yet psychiatry remains routinely and resolutely blind to its specious assertions in these areas, and continues to disseminate these “burden-of-disease” figures as a justification for their continued existence. This is emphatically not because psychiatrists are inherently stupid. Rather, it is because the primary agenda of psychiatry is the promotion of psychiatry, and Dr. Wessely is staying firmly in this role in his new position.
It occurs to me that the title of Dr. Wessely’s article may be lost on some – particularly younger – readers. In 1963, Bill Anderson, an American country singer, wrote and recorded a song called “Happiness,” the first line of which is the title of Dr. Wessely’s article. It’s a pleasant song with a catchy tune, but it didn’t do particularly well. But in 1964, the British singer/comedian Ken Dodd recorded it, and it took off. The theme of the song is that the best things in life are free. Here’s a quote:
“Happiness to me is a field of grain
Lifting its face in the falling rain
I see it in the sunshine, I breathe it in the air
Happiness, happiness everywhere”
Which strikes me as being a far cry from psychiatry’s notion that virtually all negative feelings can be banished with pills. Ken Dodd is 86, still touring, and apparently still enjoying the simple pleasures. You can see a much younger Ken singing “Happiness” here, with the late Freddie Mercury singing along (kind of). But I must warn you: if you’re the sort of person who gets tunes stuck in your head, don’t open this link!
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I have no financial ties to Ken Dodd.