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A second obstacle to being able to have a more meaningful discussion about mental health stems from our reluctance to allow people who might be suffering from anxiety, say, or — to take a more extreme example — from paranoid delusions, any degree of responsibility for their state of mind. This is meant to indicate how modern and enlightened we are. We don’t lock people up any more for being mad (actually we do, even if we no longer use that particular word), and we don’t think anyone should be ashamed for having faulty brain chemistry. You wouldn’t make them feel bad about having a broken leg, would you?

The trouble with this supposedly compassionate approach is that it robs people of their agency and autonomy, when in my experience it is the exercise — and in many cases the discovery — of these that are essential to their feeling better. Yes, “better” and “bad” imply the making of value-judgments — and nowadays these are said to have no place in the treatment of mental illness, which like the setting of a broken bone ought to be a largely technical procedure. I notice that nearly all the people I work with as a psychotherapist, however, have no trouble making value-judgments: about their families, friends and colleagues, about themselves, and also about me. I take this to be human and encourage them to explore the possible contribution of their values, along with other aspects of their character and personality, together with their overall life situation, to the unpleasant symptoms that are usually the reason for their seeking therapy in the first place. This doesn’t always make for the easiest of encounters. But that is human too — and often the very thing people find healing is being able to express the dark and sometimes cruel thoughts that preoccupy them, without these being either condemned as irrational (there’s a pill you can take for that) or condoned as normal and nothing to worry about (we’re all on a spectrum, you know).

Most modern mental healthcare, by contrast, seems to me to be conducted in a moral vacuum which it then spreads further across society. Right and wrong, good and bad, are thought to have little part to play in it, and “service-users” while held in high esteem as consumers and potential litigants are at the same time looked down on as the more-or-less mindless recipients of treatments that fail to acknowledge their capacity as human beings for making choices or forming habits. It is these choices and habits, I would argue, that are generally the source of suffering. Having said that, I would be the first to agree that the freedom someone has, say, for thinking well of themselves or of other people in the present will be greatly affected by their experiences from the past (in this example by how they might once have been thought about). But to see them only as a victim of circumstance, like someone whose leg is broken in an unfortunate accident, is to underestimate the extent to which they may be able to free themselves from the effects of the past — and conversely to remain trapped in them.

Much of the lobbying for an increase in mental health spending strikes me as caught up in a victim mentality of its own, however. The case for this is often made less on its own terms and more with regards to what the NHS already spends on all its other services, as though this was yet more evidence of the stigma there is around mental health. Frequently cited here is the 2012 legislation that actually makes it unlawful to discriminate between physical and mental health, in spite of which funding for the latter is only about half what it should be given the proportion of NHS activity (nearly 23 per cent) it takes up.

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