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.

Photo illustration by Mindy Ricketts

Stock mental health photo


5 Responses to “Self’s the Man”

  1. Zarathustra Says:

    Thanks for the kind words. Is that Morten Harkett. in the stock mental health photo?


    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.’

    If this is ‘a big assertion’, which usually means that someone is claiming something unreasonable, something that cannot be proved, then, in reply to Self, there is nothing that addresses this point that he makes :

    Much hangs on his assertion, because low levels of serotonin (and hence wanting to inhibit serotonin’s re-uptake in the brain (or parts of it) with Selective Serotonin Re-uptake Inhibitors, so that it is around for longer) might be cause or effect, and I understand it to be correct that decades of work have not established which.

    The corollary is that, if low serotonin is the effect of someone being in depression, and that their response to their life and what is happening in it is the cause, then questions arise not in relation to clinical depression, but to conditions such as bi-polar disorder, where there is supposed to be a chemical imbalance.

    We could be looking at low levels of serotonin (depression), or high ones of dopamine (high mood) : do life-events make someone’s mood high, and then high levels of dopamine result, or vice versa, and why, if that is still a question, does the pharmaceutical business still not know the answer ?

    Maybe not such a big assertion after all… ?

  3. elaine4queen Says:

    Because only people who are already famous are valuable, silly!

    Even if they are talking out of their arse. The ‘big pharma invented mental illness’ thing sounds a lot to me like something Self said at a dinner party where a commissioning editor, already his friend, said “You should write about that” and lo, he did.

  4. pocketapocketaqueep Says:

    Hear hear. That’s a dangerous piece from Self. It’s not inconceivable in my opinion that it might lead to deaths, since one of the biggest predictors of suicides in those with manic depression is that they stop taking their Lithium, one of the cures that Self places in those idiot scare quotes here.

    Lithium carbonate prophylaxis is a blunt instrument with a handful of sometimes unpleasant side effects, but it has been proven to work and lumping it with a whole slew of other treatments is truly idiotic. In failing to give an alternative, or in suggesting in some imbecilic Foucault cum Laingian counter-cultural pose that madness is socially constructed, he and the Guardian Review are playing fast and loose with the fates of those who might be considering seeking help but unwilling to try Lithium because of the many fatuous things written and said about it over the years.

    I would argue there is a case against SSRIs and the methodology behind the compilation of the DSM both, but in both instances it is much more nuanced than Self is prepared to acknowledge as he aims his blunderbuss of self-righteousness at a whole discipline.

    I have benefitted from SSRIs in the past. Not for long, and not often, but I wouldn’t have been without them at the time. I am also currently taking methylphenidate, otherwise known under the brand name Ritalin, and though it is a blunt instrument, it works.

    The most plausible arguments against SSRIs are not that they don’t work – they do – but that they can, rarely, have dangerous side effects. David Healy had a job offer reneged by the University of Toronto in 2000 when he gave a lecture in which he stated that SSRIs may be linked to suicide. The department was funded by one of the pharma giants. The lecture is worth reading, gives no truck to the anti-psychiatrists, and leaves you in no doubt Healy knows what he’s talking about. Documents from the Healy affair are collected here:

    For years I have studied nutritional and lifestyle therapies for autism, ADHD and depression. I would certainly like to see more funding channeled into the kind of research that have been done by, for example Paul Shattock ( ). I believe that there are many people who could ameliorate the symptoms of the mental disorders they suffer from solely by these means. (The most interesting section of the Stephen Fry series on manic depression a few years back was a doctor who managed her own bipolar disorder with food and behavioural adjustments who was buried in between his celebrity friends and his existential dilemma of whether to take lithium or not.) I would love to be able to do so myself. In the mean time, I’ll turn to what works, and I do not intend to be lectured to by a man who took heroin from what has always seemed to me to be little more than a youthful admiration for the odious William Burroughs.

    Oh, and to your health bloggers, I would like to add that I expect great things from @Diski, who has been writing on the subject of depression recently:

  5. This Week in Mentalists – Chin-Stroking Guardianista Edition | The World of Mentalists Says:

    […] Dunbar has a response to Self (in which he kindly namechecks both me and Seaneen […]

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