Dorothy Rowe

OpenMind - Journal of the mental health association MIND

May/June 2005

Haven't We Done Well!

Dorothy Rowe

When I was preparing to go to Australia last winter a producer of a discussion series on an Australian TV channel contacted me about making a programme on depression. I suggested that the programme should be about those people who had devised their own methods for getting themselves out of the prison of depression. A few weeks later we recorded the programme and by then the producer had found a number of people who were prepared to talk about their own successful experiences. However, when I arrived at the studio I found that, in the interests of balance, the producer had invited a consultant psychiatrist.

I shouldn't have been surprised about this. In Australia mental health is dominated by psychiatrists who believe wholeheartedly in the medical model. As I had been told by my Australian psychologist colleagues, most Australian psychiatrists see mental disorders as physical illnesses best treated by drugs and ECT with the psychological therapies being no more than optional extras. There is no NHS in Australia, and, though each State supplies some mental health care, private medical insurance pays for visits to psychiatrists but not to psychologists.

Before we began recording the presenter, Jenny, told me she would start by asking me a question which would allow me to say briefly that no evidence had ever been found for lowered serotonin levels in depression. If there were such lowered levels by now there would be a physical test for depression but none has been devised. Jenny then turned to the consultant psychiatrist. He announced in the manner of Moses handing down the Ten Commandments, 'There is biological depression. I can tell by the way the light goes out in their eyes.'

Instantly I was transported back to the early 1970s in Britain when consultant psychiatrists were the guardians of the Absolute Truth of mental illness, when psychologists gave tests and wrote reports, and patients were obedient, unquestioning and grateful for being given drugs and ECT. In the studio my experience of the bad old days was repeated every time the psychiatrist spoke because, irrespective of what Jenny asked him, he repeated, 'There is biological depression. I can tell by the way the light goes out in their eyes.' He castigated me and other therapists for telling patients that they were bad and had to change. When I replied that, since only good people get depressed, my advice is always that they should become less good he sniffed disdainfully and looked away. He refused to acknowledge the people present who told how they had ended their mental torture without recourse to psychiatrists and drugs.

One lively, passionate woman told how, after the death of her son, she had become so deeply depressed and frightened she couldn't leave her house. A friend discovered her plight and after that came every day to sit quietly with her. Gradually her friend coaxed her into the garden and then to the shops and back to driving her car again. The big change came when, in talking things over with her friend, she decided that, 'I'm me, and if other people don't like me that's their problem, not mine.' A quietly confident young man told how he had lost his nerve in dealing with people and from this lost his job, his home and his wife. Desperate and despairing, he decided to take responsibility for himself. He joined a self-help group, read books which helped him think about himself and how he saw the world, and through this put together a plan to re-build his life, something he was now doing very successfully.

Over the years I have heard a great many such stories but I never fail to be thrilled by the courage that people show when they take responsibility for themselves and step into the unknown. It is people like this who have, since the early 1970s, transformed the way mental health care is now seen in Britain. It would be a foolhardy British psychiatrist who would behave like this Australian one, because even those British psychiatrists who wish that mental disorder could be explained and treated as being no more than a physical aberration have to admit that they have to take account of how the individual sees himself and his world, and of what terrible demands life makes upon us all. Moreover, in the psychiatric system, there is general agreement that all people should be treated with dignity and respect. Of course these principles are not always adhered to, and much more remains to be done, while we must always be vigilant against the forces of unreason in high places, but, as I thought over the events of that evening in Sydney, I felt that all of us who in one way or another have been involved in changing mental health care and understanding in Britain could allow ourselves a moment of self-congratulation. Haven't we've all done well!