It’s no secret that psychiatry (and psychology, come to that) has a blemished history and that our forbears have been responsible for many crimes against humanity. It’s difficult, in an age of medical ethics and patient involvement, to consider what it must have been like to have been subject to treatments such as trepanning and lobotomy, and I know that many modern-day professionals wrestle with the treatments with we continue to prescribe and provide, even though we tend not to force people into submission. One significant exception is Sectioning, however, which effectively removes an individual’s rights and, depending on the type of Section (named so because the conditions of detention refer to specific sections of the Mental Health Act), can compel people to be treated, whether they consent or not. This perhaps merits a blog post of its own, but, regardless, it will be apparent that the concept of treatment by compulsion is fraught with dilemmas. However, as a general rule, we try to give people the right help and to only do what they are happy for us to do.
As a psychologist, I do not prescribe medication and I struggle with the notion that psychological distress can be cured by a pill. Some medications may reduce ‘symptoms’, such as we think about them, but I’ve never taken the view that all ‘mental ill-health’ is the result of chemical imbalances. Sure, there is may be an association between dopamine levels and what we call ‘psychosis’, or between serotonin and that which we term ‘depression’ but my clinical experience leads me to believe that difficult experiences are often implicated in suffering. Early adversity and trauma tend to have long-lasting effects; many of them profoundly negative. Big Pharma, of course, peddles the theory of chemical imbalance and their tactics are, whilst hardly subtle, rather dubious. Drug company-sponsored lunches at hospitals and medical schools are common, and lots of clinicians have offices containing freebies, though usually they’re nothing to get excited about. In addition, drug companies market their products like any other manufacturer would, although anti-psychotic medication is, of course, rather different to a top from H&M. This is a fairly typical ad for an antidepressant drug, although it’s a little old:
The premise being ‘take this and you’ll enjoy life. The insinuation, therefore, being ‘don’t take this and you won’t enjoy life’. In the UK such marketing is permitted only in specialist publications such as medical journals, although there is research which suggests that the more a drug is marketed the more likely it is to be prescribed. In the US, on the other hand, marketing regulations are rather more lax and it wouldn’t be unusual for the public to come across such things on public transport, in magazines and on television. Unsurprisingly, patients often go to their doctors asking for particular medications. It’s a bit of a minefield, frankly.
So far so standard. Over the weekend, though, I came across a couple of adverts on Twitter which made me deeply uncomfortable. They were tweeted by @psychiatrypics and, frankly, they didn’t go down too well with the social media collective. Exhibit A:
Ludicrous to describe bipolar disorder, characterised by extreme highs and lows in mood, as akin to ‘war’ and offensive to suggest that ‘peace’ can only come in the form of a pill. Stigmatising as well, to suggest that everyone who has such highs and lows would necessarily want and need medication; that one could not live normally and well, despite such fluctuations. Hugely powerful, nevertheless. Exhibit B, then:
A more abhorrent load of tosh I could not imagine. There are so many things wrong with this I barely know where to begin. Let’s start with the facts. van Gogh died in 1890. The term ‘schizophrenia’ was coined in 1911 by Eugene Bleuler, although its linguistic predecessor, dementia praecox, was in use in the early 1890s. Regardless, van Gogh never received a diagnosis of any kind and it is crass and unhelpful to diagnose him posthumously. He was obviously a troubled man, but a troubled man who created some of the greatest art the world has ever seen. To assume that a tablet would have stopped him being troubled (look at his lovely smile!) is nothing more than marketing hocus pocus; completely impossible to prove one way or the other. And then there is the small matter of the fact that, had it not been for the fact he was a troubled man, we might never have had a self-portrait to begin with. We might never have had Night Stars or Cafe Terrace, two of my favourite paintings. Yes, van Gogh was touched by things which were obviously painful; he was also touched by genius. Perhaps those attributes could only exist in tandem. Perhaps Zeldox would have calmed the things which tormented him but we will never know for sure. To suggest that it would have prevented him cutting his ear off trivialises his suffering, and that of all those who are similarly troubled. It is offensive, and, because of the implicit promise it makes to people who may be in deep distress, and those who care for them, it is manifestly dangerous.