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Thus we hear a lot about mental health services being “poor relations” or “second-class citizens” within health provision as a whole, and of the need to achieve “parity of esteem” by campaigning against the prejudice and discrimination that always hold this sector back. To my mind this politicises the language of mental health and is the third reason it can often seem so full of sound and fury while not signifying very much.

The fourth reason relates to the question of resources and what we as a society decide to spend our money on. Mind-altering substances like alcohol have always been popular, and it is well-known that in the 19th century there was widespread use of preparations containing opium until a reaction against that led to be it being regulated — at which point the medicinal and recreational qualities of cocaine were promoted instead. That too was banned, to be replaced by the new phenomenon of synthetically-manufactured “pscyhopharmaceuticals”. Over the course of the 20th century, amphetamines (uppers) and benzodiazepines (downers) passed in and out of official favour. Sometimes these were widely prescribed for a variety of physical and psychological complaints. At other times production and prescription both plummeted as concerns were raised about their addictive properties or the threat posed by a “turn on, tune in, drop out” type of drug culture.

More recently, pharmaceutical companies and psychiatrists — often working closely together — have tried to isolate a swathe of psychoactive substances from these concerns, by advancing a disease-centred model of mental illness in which for every specified cluster of symptoms there is a drug that is said to target precisely those symptoms. Attention Deficit Hyperactivity Disorder? No problem, we’ve got just the product. Hearing voices or seeing things? Try this new brand of anti-psychotic medication.

This is meant to to be a far cry from the era of “mother’s little helper”, when Valium was dished out liberally as an all-purpose calmative. It also allows for a principled stand against drugs like cannabis or heroin that are not medically prescribed and which continue to be illegal. The problem is, though, not only that in spite of the claims they make to be reversing a chemical imbalance in the brain, many psycho-pharmacological drugs operate as uppers/stimulants or downers/sedatives by another name, but that thanks to these having become normalised and almost as much part of the conversation you might expect to have with your GP as statins, the population is now on levels of mind-altering substances such as Timothy Leary — the counter-cultural guru who coined the slogan “turn on, tune in, drop out” back in the Sixties — might have dreamt of on one of his wilder acid trips.

In recent years there has also been a dramatic increase in the number of opioid painkillers prescribed for the treatment of chronic pain. This group of drugs is associated with serious side-effects and withdrawal difficulties too, the latter adding to the risk of long-term dependency. According to the All-Party Parliamentary Group for Prescribed Drug Dependence, over one million patients in England are unnecessarily taking addictive, psychoactive drugs (primarily benzodiazepines, anti-depressants, opioids and sleeping tablets), and in 2017 it began campaigning to set up a national helpline to support them.
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