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Opinion Mental health

This article is more than 11 months old

I’m a psychologist 0 and I believe we’ve been told

devastating lies about mental health
Sanah Ahsan

Society’s understanding of mental health issues locates the

problem inside the person 0 and ignores the politics of their
distress
Tue 6 Sep 2022 12.00 BST

‘Doesn’t it make sense that so many of us are suffering? We are living in a traumatised world.’ Photograph: A

W
Room With Views/Alamy

e are living, we’re told, through a “mental health crisis”.

Mental health services cannot cope with the explosion of
demand over the past two years: 1.6 million people are on
waiting lists, while another 8 million need help but can’t even
get on these lists. Even children are showing up at A&E in
despair, wanting to die.

But there is another way to see this crisis – one that doesn’t place it firmly in
the realm of the medical system. Doesn’t it make sense that so many of us
are suffering? Of course it does: we are living in a traumatising and uncertain
world. The climate is breaking down, we’re trying to stay on top of rising
living costs, still weighted with grief, contagion and isolation, while
revelations about the police murdering women and strip-searching children
shatter our faith in those who are supposed to protect us.

As a clinical psychologist who has been working in NHS services for a

decade, I’ve seen first hand how we are failing people by locating their
problems within them as some kind of mental disorder or psychological
issue, and thereby depoliticising their distress. Will six sessions of CBT,
designed to target “unhelpful” thinking styles, really be effective for
someone who doesn’t know how they’re going to feed their family for
another week? Antidepressants aren’t going to eradicate the relentless racial
trauma a black man is surviving in a hostile workplace, and branding people
who are enduring sexual violence with a psychiatric disorder (in a world
where two women a week are murdered in their own home) does nothing to
keep them safe. Unsurprisingly, mindfulness isn’t helping children who are
navigating poverty, peer pressure and competitive exam-driven school
conditions, where bullying and social media harm are rife.

If a plant were wilting we wouldn’t diagnose it with “wilting-plant-

syndrome” – we would change its conditions. Yet when humans are suffering
under unliveable conditions, we’re told something is wrong with us, and
expected to keep pushing through. To keep working and producing, without
acknowledging our hurt.

In efforts to destigmatise mental distress, “mental illness” is framed as an

“illness like any other” – rooted in supposedly flawed brain chemistry. In
reality, recent research concluded that depression is not caused by a
chemical imbalance of the brain. Ironically, suggesting we have a broken
brain for life increases stigma and disempowerment. What’s most
devastating about this myth is that the problem and the solution are
positioned in the person, distracting us from the environments that cause
our distress.

Individual therapy is brilliant for lots of people, and

antidepressants can help some people cope. But I worry
that a purely medicalised, individualised understanding
of mental health puts plasters over big gaping wounds,
‘I’m glowing’: without addressing the source of violence. They
scientists are
unlocking secrets of encourage us to adapt to systems, thereby protecting the
why forests make us status quo. It is here that we fail marginalised people the
happy
most: Black people’s understandable expressions of hurt
Read more at living in a structurally racist society are too often
medicalised, labelled dangerous and met with violence
under the guise of “care”. Black people are more likely to be Tasered,
sectioned, restrained and over-medicated than anyone else in our mental
health services today.

The UK could learn a lot from liberation psychology. Founded in the 1980s
by the Salvadorian activist and psychologist Ignacio Martín Baró, it argues
that we cannot isolate “mental health problems” from our broader societal
structures. Suffering emerges within people’s experiences and histories of
oppression. Liberation psychology sees people not as patients, but potential
social actors in the project of freedom, valuing their own lineages, creativity
and experience, rather than being forced into a white, eurocentric and
individualistic idea of therapy. It directly challenges the social, cultural and
political causes of distress through collective social action.

This framework makes complete sense when we hear that the pandemic in
the UK has affected poor people’s mental health most. Does it mean wealthy,
privileged white men don’t experience suffering? Of course they do. We’re
still learning about the complicated ways these structural issues affect our
everyday lives. For example, how the pressures of individualism and
capitalism may lead to isolation and substance abuse, or how colonial
violence towards immigrant families plays out within homes and on bodies.

Let me be clear, I’m not saying people in distress should be out there on the
picket line. Pain can be debilitating. But those of us who are supporting
people in distress, such as mental health workers, have a key role in social
transformation. Social action is the medicine that relieves people’s personal
and collective distress.

Instead of trying to change “mindsets” in therapy, we need to change race-

and class-based hierarchies, the housing and economic system. Universal
basic income has psychological benefits, and recent studies show how it
improves the “crises of anxiety and depression”. As a clinical psychologist,
some of my most powerful work has been not in the therapy room but in
successfully advocating for secure housing for, or working in the community
with, queer, black and brown facilitators in organisations such as Beyond
Equality, to prevent gender-based violence. The network Psychologists for
Social Change shows us a practical imagining of this work. We also need
social change that is preventive, such as investing in young people and
community-led services such as healing justice london and 4front. They
work to shift trauma in marginalised communities through building social
connectedness, social action and creativity, towards futures free of violence.

None of this is to dismiss the value of one-on-one therapy (that’s part of my

job, after all). But therapy must be a place where oppression is examined,
where the focus isn’t to simply reduce distress, but to see it as a survival
response to an oppressive world. And ultimately, I’d like to see a world
where we need fewer therapists. A culture that reclaims and embraces each
other’s madness. Where we take the courageous (and sometimes skin-
crawling) risk of turning to each other in our understandable, messy pain.

Meaningful structural transformation won’t happen overnight, though the

pandemic taught us that big changes can happen pretty quickly. But change
won’t happen without us: our distress might even be a sign of health – a
telling indicator of where we can collectively resist the structures that are
hurting so many of us.

To return to the plant analogy – we must look at our conditions. The water
might be a universal basic income, the sun safe, affordable housing and easy
access to nature and creativity. Food could be loving relationships,
community or social support services. The most effective therapy would be
transforming the oppressive aspects of society causing our pain. We all need
to take whatever support is available to help us survive another day. Life is
hard. But if we could transform the soil, access sunlight, nurture our
interconnected roots and have room for our leaves to unfurl, wouldn’t life be
a little more livable?

Dr Sanah Ahsan is a clinical psychologist, poet, writer, presenter and

educator
Do you have an opinion on the issues raised in this article? If you would
like to submit a letter of up to 300 words to be considered for
publication, email it to us at [email protected]

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Topics
Mental health < Opinion
Health / UK cost of living crisis / Psychology (Education) / Psychology (Science) / comment

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