The Rise of Antidepressants

The BBC ran a news piece today about the massive rise in use of antidepressants in England and Wales over the last 10 years. And depending on which study you believe between 1 in 11 and 1 in 6 people in England are now on an antidepressant (though we must remember, that antidepressants can be used for other conditions like pain management and irritable bowel syndrome – IBS). In the USA, antidepressants are now the second biggest group of prescribed drugs.

 

So, what should we conclude? Well, firstly, it is good news that it has become much more acceptable for people to talk about struggling with depression, anxiety and other mental health issues. It is good that people are going to see their GP when they feel depressed and anxious, rather than just trying to cope with it. So, we mustn’t now necessarily insinuate that the increase in prescriptions is a bad thing, because firstly, that can heap shame on those who are taking them, which is unhelpful at so many levels and also, we need to remember that there is actually a good evidence-base behind anti-depressant medication. They really do work – I’ve seen that again and again for my patients, who choose to go on them, and for sure, I would love to see more psychological therapies available on the NHS, as an alternative or as an adjunct to medication. Waiting lists are currently far too long for such therapeutic interventions and many people choose medication because they cannot afford to pay for therapy or indeed to wait several months for the help they need. We don’t report the use of antihypertensives to control blood pressure negatively and so we need to be careful about taking a dim view of medications which help improve mental health.

 

However, when so many in our society are struggling with anxiety and depression to this extent (and it’s really positive that we’re talking about it and that people are getting help), we need to ask ourselves some big questions about the root causes of this and what we can do as a nation to improve our mental health. One of all time favourite quotes is that of Archbishop Desmond Tutu, when he says:

 

“There comes a point, where we have to stop just pulling people out of the river. We need to go upstream and find out why they are falling in.”

 

So, in the rest of this blog, I’m going to explore some root causes, whilst recognising that for many people, endogenous depression (i.e. a neurochemical cause in the brain) IS the root cause, and therefore their depression may not have any other roots to it.  I’ve also done this vlog (which I did for mental health awareness week) about what depression is and some of the things that can help.

 

But in looking for root causes, let’s start at the beginning. I’ve written on this blog a number of times about the impact of Adverse Childhood Experiences and the impact of Trauma on our lives. So many of us live with unhealed pain, which over time eats away at us and makes it harder for us to remain mentally well. Many of us go through trauma and are able to survive it better than others, but that is because we’ve had other things in our lives at the time which have helped us navigate the storm. However, we need to recognise more the massive reality of trauma in our lives, so that we can face it, and find healing together. This is one of the reasons why I’ve co-written ‘The Little Book of ACEs’ with some friends and colleagues, here in Morecambe Bay. There is a free PDF version of it, if you click here. You may also find this inspiring talk by Jaz Ampur-Farr, herself a survivor of significant trauma, really helpful. Jaz is joining us in Morecambe Bay very soon, to explore some of these issues.

 

We must also be brave enough to recognise that we have a complex corporate history, which shapes our identity and we have a society, which is by no means equal or fair. Prof Bev Skeggs, and Prof Imogen Tyler, two of the foremost sociology professors in the UK/world right now, are writing so powerfully about this. It’s well worth digging into their work, and I am so excited that they are here at Lancaster University, in Morecambe Bay, and will be exploring some of these issues with us in more depth over the next few months. We cannot underestimate how injustice, poverty, and inequality impacts our mental health.

 

Stress has a hugely negative impact on our mental health. Our work patterns have become so manic and busy and our weekends often so full, that we have forgotten how to rest, how to stop, how to switch off and take notice of the beauty all around us – of the things which really matter. This takes a huge toll on us. The girl guides took part in a fascinating survey about what causes them stress and feeds mental health issues. The number one factor was the pressure they feel to do well at school. Our very systems and the treadmill of the exams are making our young people unwell. The idea of slowing down and learning to switch off from our ever faster, consumerist world, seems laughable to so many of us – and yet I would argue that this is one of the greatest causes of our ill-being. We have created an economy which treats people like fodder for the economic machine and is literally killing the planet around us – another underlying huge but often unrecognised cause of our stress. We must rebuild an economy based on wellbeing. It’s why I’m so excited that we’ll be welcoming Prof Katherine Trebeck to Morecambe Bay in the next few weeks.

 

Another causative factor of our growing mental illness in society, perhaps caused by all the busyness, is loneliness and isolation. Despite our many frantic activities, and social networking, 20% of the UK population say they feel lonely, but that jumps to between 50 and 75% of people over 75. We were made to be in relationship. When we are disconnected from community, we become sad and low. We need to remember how to love people, and also to be loved. Our disconnection is leading to increased separation, suspicion of others and a rise in racism and hatred. This is in no way good for our mental health. Valerie Kaur explores this so powerfully in her incredible TED talk on revolutionary love. We need to reimagine a society in which relationship is at the core of our being together. Hilary Cottam’s work is so vital in helping us recover this. Again, Hilary is coming to the Bay in the coming months to help us dig deeper as a community into these ideas.

 

I am so glad that we are talking about mental health so much more seriously. I am glad that people are able to take medication that can help them and that the stigma is being broken. I am hopeful though that we can recognise together just how broken our society is, and how our current political and economic systems (including our beloved health system) cannot fix this. Perhaps, in learning to be together in the dark, when we cannot see the light, wrestling with the complexity of our pain, healing our trauma and reimagining our future, we might find that our need for medication decreases.

 

 

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Truth about Poverty

One of the best things I have been involved in over the last few years, is the Poverty Truth Commission and it has helped me to learn just how utterly complex and wicked poverty is as an issue. I’m currently reading an absolutely brilliant book by the theologian Samuel Wells, called ‘The Nazareth Manifesto’. In it, he makes the most accurate diagnosis of poverty that I have ever seen and it rings true of my work in clinical practice, my years of helping out in homeless projects in Manchester, my time spent in Sub-Saharan Africa, the poverty truth commission and my involvement in projects around food poverty.

 

Wells recognises the biggest issues in our society right now are caused by our massive obsession with mortality and our drive to overcome our human limitations. Using poverty as an example, he goes on to demonstrate that none of our current under-girding political or economic philosophies will get us even close to addressing the real issue. Our real issue is that we are isolated and dislocated and our breakdown in relationship leads to the deep sickness that we have in society right now. I don’t think I have ever seen this United Kingdom so utterly divided and truthfully, none of our current available options will bring us the unity we need to heal, forgive and find an altogether kinder and more sustainable future, together. It is our division which leads to the stark contrasts in life expectancy of people who live just six miles apart in Morecambe Bay. It is our dislocation that leads to such different life stories in Chelsea from the people who so tragically lost their lives in Grenfell. It is the disconnection between the City of London and Tower Hamlets that allows such gulf between the rich and poor.

 

When we look at the NHS 10 year plan, (apart from the fact that there isn’t the workforce around to deliver it and our local government budgets have been so utterly decimated that the gaping hole in public health and social care will ensure the plan fails), it is based on a defunct philosophy of needing to overcome our limitations. The NHS cannot save us from our current sickness of separation and isolation and nor can we expect it to.

 

Taking the example of poverty, Wells examines our current motifs for explaining this very complex issue and what it shows us about society. Poverty is currently explained through either Deficit or Dislocation. The ‘deficit metaphor’ can be illustrated in three ways:

  1. The desert narrative explains that people are poor because the do not have enough (of whatever) and so this can be ‘fixed’ by transferring resources. However, he shows this is deeply flawed as a parable because it dehumanises those who live in poverty, creating an ‘us and them’ mentality in which the rich/powerful try and fix the issue via ‘quasi-colonial’ approaches or use things like food aid to effectively control local populations in abusive ways.
  2. The defeat narrative focuses more on winners and losers and takes quite an unhealthy emphasis on the role of ‘personal responsiblity’ without really considering the other very complex factors like public policy and housing prices….
  3. The dragnet narrative is what the Millenium Development Goals are actually based on (see ‘The End of Poverty’ by Jeffrey Sachs) and considers poverty to be a dragnet/trap which makes it impossible for the poorest to even get onto the bottom rung of the ladder so people can climb out. It focuses on redistribution of wealth via 0.7% of GDP but is very paternalistic and is about doing to or working for, rather than a collaborative ‘together with’ approach.

The ‘dislocation metaphor’ likewise can be understood in triplicate:

1. The dungeon narrative explains poverty not as scarcity but as sin. It is either due to the sin of people who unjustly lock up the poor through their own greed and unfair policies. Or it is understood as the sin of people through making bad choices and therefore ending up trapped in their own prison. However, it still relies on external factors to fix it and so generally remains highly paternalistic.

2. The disease narrative explains poverty as a sickness which lives in our relationships, communities and societies. It recognises that, just like disease, poverty is extremely complex and multifactoral and so does not focus on apportioning blame.

3. The desolation narrative focusses on symptoms>causes, for example how the reality of poverty has a far greater effect globally on women than men – leading to major injustice, oppression and abuse of women across the globe.

 

Wells argues that the reality of poverty, whether local or global is primarily due to isolation and our obsession with mortality and overcoming human limitation is actually making our isolation even worse and therefore making us more sick. And for Wells, poverty is not fundamentally about the absence of money or the lack of conventional forms of power (although this is a part of it), but it is far more about the impoverishment, the industrialisation, the manipulation, the breakdown or the perversion of relationship. It is our isolation from one another that leads to exasperation, impatience, the pointing of fingers, blame and the villifation of ‘the other’. Just look at the polarisation on twitter between the right and left and the appalling name calling and slinging of mud and you see exactly what I mean.

 

The reality is that neither of our increasingly polarised political options is going to heal us or help us find a future that will be good for humanity or the planet. Our political ideologies are so opposed between liberty (right wing) and equality (left wing) but neither is equipped to help us break through this curse of isolation and find a new way forward together. I believe that we have reached a critical point in which we need to find an altogether kinder, more compassionate and collaborative politics and economics that is based first of all on humble listening and genuine democratic conversation to help us find a way forward together, rather than this current division and hatred. I believe as we find each other and build relationships (something which social media can so easily rob us of), we come to appreciate our different perspectives, learn from each other and find that we actually care about each other. I know, for sure, that by learning to BE WITH rather than DO TO or even WORK FOR has really changed how I see others and how I believe we can build a fairer and kinder society for everyone. It demands humility and forgiveness, based on a self-giving, others-empowering love as we build positive peace and requires of us, personal change and the dealing with our own self-centredness as we discover the beauty of connectedness to all people and all things. Theology shapes a great deal more of our philosophy and life together than many of us would care to accept! Well’s thesis is that the character of God is first and foremost discovered in these four words: ‘God is with us’. So often we think of people having a ‘God-complex’ who are people who think they know everything and do things to people because they know how to fix things. It smacks of arrogance. What if God isn’t like that at all? What if the most important thing to God is being with people? What if ‘being with’ is where it’s at and ‘doing to’ and ‘working for’ is to miss the point of what it means for us to be human and whole?

 

I wonder if we are brave enough to let go of that which is actually killing us and the planet and begin to find an altogether different way forward, together. Isolated, we die. Together we live.

 

 

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A-Z of Health and Wellbeing

Tweet Happy New Year!   We often start a New Year with resolutions, things which we would like to change for the better. so, I thought I’d start this year of blogging with a vlog about my perspective on the A-Z of what affects your Health and Wellbeing the most.   It’s longer than most [Continue Reading …]

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Hosting Conversations That Matter

Tweet In my last blog, I was exploring how some of the biggest determinants of our health and wellbeing have very little to do with healthcare at all. They are societal issues, with huge implications on how we live together. Issues like poverty, homelessness, loneliness and adverse childhood experiences are far greater drivers of health [Continue Reading …]

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A 3 Fold Approach to Population Health

Tweet Here in Morecambe Bay, we are trying to develop a strategy around Population Health – by that we mean we want to take a much broader view of the health needs of those who live in this area, ensuring that we try to tackle the disparities we see in the health of our population. [Continue Reading …]

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