In the bleak midwinter

‘Whether Buddhist, Christian, or Stoic, the central idea is that the human condition involves suffering. By contrast, the new religion of wellbeing demands constant happiness’

Open Season

Christmas can be a bleak time of year. While some feel isolated, others are overwhelmed by the need for a perfect family Yuletide when their reality is different.

Celebrity awareness-raising campaigns about the importance of looking after our mental health and a slew of NHS-driven initiatives to help people cope with their everyday psychological wellbeing should make it easier to admit to feeling blue beneath the sparkly tinsel and bright lights. As the author of Black Rainbow, a memoir of two severe depressive episodes in my thirties, when I was suicidal and went to hospital,  I should be celebrating this reduction in stigma. But I fear we are muddled.

High-profile attention to mental health confuses what Freud called “ordinary human unhappiness”,  a natural response to stress, with clinical depression. This is a life-threatening condition of severe mental distress which hounds only a few of us. We also confuse mental and physical illness. The Archbishop of Canterbury, Justin Welby, said his own bout of depression differed from physical illness only because it was invisible, and had a stigma attached.

Mental distress can indeed be as life-threatening as physical illness. But we do not know its exact nature or its chemical mechanisms. There is no proven pathology and we have no biological markers, such as blood or urine tests, for depression. The parallel also suggests that there is something wrong with your brain-functioning, rooted in chemistry and genes, and the only solution is drugs provided by a psychiatrist. In other words, recovery is out of your hands.

Yet many simple activities instil resilience and promote peace of mind without resort to medicine, including reading to give perspective, breathing exercises, healthy eating, mindfulness and yoga. Taking responsibility for your own mental fitness, rather than relying on healthcare professionals, gives you a sense of agency. This was one reason that I wrote Singing in the Rain, a mental health workbook.

One idea is a “worry log”: I divide my concerns into those for which I can devise an action plan—which I do—and those with no obvious solution, where I need to find acceptance. Once something is noted, I feel more in control rather than at the mercy of my anxious mind.

To remind myself of my own power, I start my day as I mean to go on by taking care when making my bed. Tidying the duvet and pillows puts me in the right mood to continue a sense of control throughout the day. People in positions of power often adopt these tactics to establish a sense of control when entering a boardroom or unfamiliar environment. They might change the position of a glass or alter the height of the microphone on a pulpit or reshuffle their papers.

Another helpful step is to rephrase statements about your own powerlessness. Language itself can make us feel more of a victim and gives our power to others. Instead of saying, “I’m never going to get on top of all the work I’ve been given,” try: “Over time I can learn how to manage my workload.”

Finally, being kind to others makes us kinder to ourselves, developing a more compassionate, accepting inner voice, which you can call upon to help you counteract negative thinking.

We risk losing religious and spiritual practices that traditionally have been our friends. Whether Buddhist, Christian, or Stoic, the central idea is that the human condition involves suffering. By contrast, the new religion of wellbeing demands constant happiness. If you are not happy, then here’s some pills to sort it out.

A more spiritual solution to suffering would be acceptance of it as part of the human condition; teaching our children at an early age to find coping mechanisms for the reality that awaits them (life is tough); and attempting ourselves to find answers to our own dissatisfied minds and lives, whether that is through counselling, or changes in lifestyle—or in public policy.

We also need to rethink how we help those who are experiencing acute, life-threatening mental health conditions. That means better psychiatric care. NHS Providers, which represents hospitals, says that mental health patients are at increasing risk from ageing and often unsafe buildings. The Royal College of Psychiatrists says that the number of unfilled consultant posts has doubled in just six years. Vacancy rates are particularly high in children’s mental health and in the treatment of eating disorders—the deadliest mental health conditions.

Even more pressing is the need for research. The charity MQ reports that 25 times more is spent per patient on research into cancer compared with mental health. Only 50p, the price of a chocolate bar, is spent per person annually on research into new treatments. From public funds, cancer research receives £195m, dementia gets £177m and all of mental health combined—anxiety, depression, schizophrenia, and bipolar—
receives only £121m. Delving into mental health has lagged so far behind that we are still pondering the basics of how the brain works. In the absence of more knowledge, or new drugs, we have little to offer the seriously ill other than existing medication, which we know fails to work for at least a third of people. The mental health charities, who should lead here, show little interest in asking people to donate to research, apart from a few honourable exceptions such as SANE.

My prescription, in short, would be developing other ways of coping with unhappiness, with less medical intervention; plus more research, better treatment and new drugs for the seriously unwell. Only then will we increase our capacity for joy and understand the true nature of mental illness.