Self’s the Man

There is a ludicrous piece on mental illness in the current Guardian Review, symptomatic of a debate that is beginning to unclip itself from reality’s moorings. It’s by the novelist Will Self, who makes several big assertions: first that ‘no fixed correlation has been established, despite intensive study, between levels of serotonin in the brain and depression.’ He also states that ‘big pharma has moved into markets outside the English-speaking world and effected a wholesale cultural change in [our] perception of sadness (rebranding it, if you will, as chemically treatable ‘depression’), simply in order to flog their dubious little blue pills’. In the next para, he gets more direct, naming ‘the fiction of depression as a chemical imbalance that can be successfully treated with SSRIs.’

This is a big idea: that the concept of depression has to some extent been invented by a Big Pharma conspiracy, working with the medical establishment to push barrels of chemical relaxants as treatment for hypothetical conditions. Self’s probably aware of the literary antecedents of this big idea, notably Huxley’s Brave New World. Or maybe I’m being too hard on him, and he thinks this is a natural evolution rather than corporate skulduggery: ‘the tail can begin to wag the dog: rather than arriving at a commonly agreed set of symptoms that constitute a gestalt – and hence a malady – psychiatrists become influenced by what psycho-pharmacological compounds alleviate given symptoms, and so, as it were, ‘create’ diseases to fit the drugs available.’

I don’t think anyone in the psychiatric profession, not even the psychiatrists that Self critiques, would deny that antidepressants are over subscribed. Access to talking therapies is a long process and something has to be done to cosh immediate symptoms. The mental health nurse Phil Dore, when I tweeted this, said that ‘I regularly see living disproof that SSRIs can’t help depression.’ I’d go farther: I think there are people walking around and breathing who would not be if not for medication.

I also struggle to think of a branch of the medical profession that is so demonised as psychiatry. The same paranoid rhetoric is not levelled against oncologists or thoracic surgeons, even though bad things happen on any doctor’s watch. The Scientology-like hatred of an entire branch of medical science helps no one.

To declare certain psychological conditions as ‘fiction’ seems edgy and interesting, in the pages of the Guardian Review, but the flipside to Self’s argument is that anyone who claims to be suffering from depression is simply trying to get attention and needs to get over themselves. We have spent years getting over this philistine reflex, and here it is back in a Shoreditch rebrand.

Let’s agree that antidepressants are overprescribed, that they are never a whole solution, and that there are problems with the gigantic drug companies. How then do we treat mental illness (and Self does say that mental illness in general does exist, calling it ‘an extremely frightening phenomenon to observe – let alone experience.’) What is the best way of tackling such awful problems? Self offers nothing. He links closed mental health units to the cliché of Victorian bedlam, but in the same para, complains about the ‘care in the community’ policy of the 1990s. He offers no solutions. He just writes sentences like ‘This in itself, Davies might argue, explains why there are more and more new ‘diseases’ with each edition of the DSM: it isn’t a function of scientific acumen identifying hitherto hidden maladies, but of iatrogenesis: doctor-created disease.’ Seriously though, doesn’t Self realise that all this stuff was done by R D Laing back in the 1970s and it was widely recognised as idiocy even then?

Here’s an idea. Why don’t the broadsheet newspapers commission one of the great mental health bloggers out there to write something about mental illness. Sure, Zarathustra and Molly Vog aren’t big creative names and haven’t won any awards. But they do at least have the virtue that they know what they are talking about, and have many more interesting things to say, too.

Stock mental health photo