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We need to tackle societal problems to stem the tide of mental illness

Dr Youssef El-Gingihy

Dr Youssef El-Gingihy

As a GP and the son of a psychiatrist, I have been fascinated by mental health from a young age. We are living through an epidemic of mental illness; the WHO ranks depression as the greatest cause of disability in the world. Anxiety, loneliness and personality disorder have become widespread.

According to a recent MIND survey, 40% of GP appointments include a mental health issue.

Psychologists have noticed a surge in personality disordered patients populating their waiting rooms. Politicians, commentators and celebrities now talk openly about mental health issues. However, there is very little analysis of the reasons behind this epidemic.

One contributing factor is almost certainly the increase in the identification and labelling of mental illness, as reflected by the ballooning of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is greater awareness amongst the public and more people are able to come forward to get help due to reduced stigma. There is also likely a good deal of over-diagnosis, with millions of children in the US now labelled with – and medicated for – ADHD.

But these factors surely don’t entirely explain why millions of people in the UK are now suffering with mental illness and taking antidepressants. To help us understand, we have to look at how the aetiology of mental illness extends beyond the clinical realm into social and economic spheres. From the 19th century onwards, Marx, Freud and others theorised that mental distress was linked to social changes. Freudo-Marxist Christopher Lasch argued that morally repressive societies such as Victorian Britain promoted neurosis, and that this was overtaken by personality disorder in a more permissive, liberal age.

While the mantras of choice might apply to dating and fashion, most people have very little choice over socioeconomic realities such as jobs, wages and housing

Narcissism specifically may now be the personality paradigm of our deregulated, neoliberal 21st century capitalist era; Jean Twenge and W Keith Campbell argue that narcissistic traits are increasing. And, while narcissistic personality disorder remains relatively rare, it’s remarkable how the check-list of pathological narcissistic traits – excessive self-obsession, grandiosity, superficial charm and shallow affect, all-consuming rage, manipulation and exploitation of others, emptiness with the tendency to mirror others, parasitic attachment, promiscuity and lack of empathy – reflect much of what we are surrounded with. They appear to fit hand in glove with the cult of celebrity and obsession with image promoted by advertising, consumerism and social media.

Furthermore, consumers are bombarded with marketing and advertising focused on aspirational lifestyles. Yet while the mantras of choice and agency might apply to dating, fashion and general behaviour, most people have very little choice over socioeconomic realities such as jobs, wages and housing. This disconnect can generate a sense of failure, frustration, rage and impotence.

All this is certainly in keeping with what we understand today around the social determinants of health generally and how mental illness correlates with socioeconomic status. Indeed, in The Inner Level – the follow-up to their widely acclaimed The Spirit Level – Kate Pickett and Richard Wilkinson argue that rising inequality is connected to the surge in mental illness.

So what are the solutions? Psychological therapies, such as cognitive behavioural therapy (CBT) help some. However, as one psychologist confided to me, CBT appears to be ‘a neoliberal solution in a neoliberal age’. With CBT, both therapist and patient are focused on changing the individual’s negative patterns of thinking and behaviour – admittedly a more manageable task – rather than looking at structural or systemic factors that are impacting on their mental health.

In spite of government rhetoric on parity of esteem for mental health, cuts and closures have hit hard and served to compound the crisis. Children and adolescents are forced to travel hundreds of miles to access inpatient beds. Much of this dates back to the Care in the Community programme of the 1980s leading to the closure of psychiatric institutions. Without the necessary investment in community resources, patients with serious mental illness have been left stranded without the help that they so badly need.

Since 2010, things have only got worse. Austerity has been linked to 120,000 excess deaths in health and social care. The literature on the links between economic crisis and mental health is extensive. It is no surprise that there is a greater burden of depression, anxiety and stress with increasing poverty, deprivation and inequality alongside the housing crisis, benefit sanctions and stoppages as well as cuts to social care for the most vulnerable.

Citizens are, in effect, forced to internalise a failed economic model of global capitalism. The solutions lie not just in increasingly sophisticated therapies but in the way we lead our lives and the structure of our societies.

Dr Youssef El-Gingihy is a GP in east London

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Readers' comments (10)

  • Seriously? You have it backwards. You think in the UK its capitalism that's responsible for our current economic state? No, its socialist policies/increased state intervention & spending. Austerity is a myth. Spending/borrowing/our deficit has continued to increase under the 'fake Tories'. You're right clearly, in that mental health is linked with socioeconomic status i.e. level of meaning/responsibility in one's life. You want to help lots of people? You give them as much responsibility as they can bear, the freedom to exercise their choices, and trust in the innate altruism that most of us have.

    You might be a great GP, but you're no economist, clearly. Time to read some Milton Friedman, and Jordan Peterson.

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  • "We need ------ to stem the tide of mental illness".

    "One contributing factor is almost certainly the increase in the identification and labelling of mental illness" --

    "There is also likely a good deal of over-diagnosis" ---

    Agreed.

    Labelling and over-diagnosis cause great individual, and family suffering.

    Psychotropic drug-induced neuro-toxicities (ADRs) may be life threatening in intensity, for example SSRI/SNRI induced akathisia.

    These ADRs are vulnerable to misdiagnosis, resulting in labels-for-life.

    In addition to physical/neurological injury: -

    ADRs to psychotropic drugs cause changes in thinking, emotion or behaviour, associated with distress and problems in social, work or family activities.

    Yet, these common ADRs are most likely to be interpreted as emergent, severe mental illness.

    This is because of how mental illness is defined:

    The American Psychiatric Association Defines Mental Illness as follows:

    "Mental illnesses are health conditions involving changes in thinking, emotion or behaviour associated with distress, and problems functioning in social work or family activities".

    In addition to akathisia's writhing, contorted "restlessness" and
    the intense, intolerable suffering for the patient, and the desperate anguish of partner, parents, loved ones (who are not warned to look out for this common ADR): -
    The toxic patient is then likely to be exposed to higher doses of, and/or additional akathisia-inducing psychiatric drugs.

    The resulting increased intensity of akathisia is then re-interpreted as further evidence of SMI.

    Section, enforced, long-term drugging and multi-systems toxicity results in physical, psychological, social, emotional and economic injury.

    How many of those condemned by inclusion on the S.M.I. Register are mis-labelled ADRs?

    Many may have no mental illness, especially those given SSRIs for life's normal day-to-day stressors where there was no depression whatsoever.

    Societal rejection and societal exclusion may well follow.

    The reality of the much publicised, changing psychiatric epidemiology cannot be accurately interpreted until misdiagnosis due to prescription drug ADR is addressed in detail and without prejudice.

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  • David Banner

    So much effort has gone into raising awareness, reducing stigma, early diagnosis and “defeat depression” campaigns, but nobody seemed to realise that doubling or trebling the patient population needed a corresponding rise in psychiatric services.

    So now the Adult team have learnt from CAMHS that all you do is reject vast swathes GP referrals, or discharge everybody after one appointment with a letter to GP asking for multiple medications to be titrated up.

    The result? Huge numbers of dissatisfied patients labelled with dubious mental health diagnoses swamping GP surgeries moaning about the lack of care available.

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  • David Banner- spot on. “Awareness campaigns” aka pharmaceutical companies increasing their markets

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  • Mental health issues affect all of society not just the poorer- it is not class specific! A review into postnatal suicides showed it was mainly white middle class women at risk.....a group who can be conveniently overlooked by health visitors etc as “not needing input”.
    My plea..... leave politics out of medicine!
    Treat what needs treating, however it needs treating for that individual ....... every individual has equal health needs for GPS- maybe different needs but equal needs! GP is NOT the realm for health inequalities or societal problems- that’s a wider public health issue and it is dangerous to fall into that path as GPs.
    Eating disorders in teens, self harm, psychosis, alcohol, depression, bipolar........... that’s not bloody austerity related- the push back to GP is enormous- as the reader above commented the most shocking, serious referrals are “ discharged back to care of GP”- no input?! All lies at our door- who do we discharge to?

    Public health can do targeted work in communities etc- for sample......but everyone has an equal right to care and treatment too
    GPs are uniquely placed to provide individual care to ALL....irrespective of social class/ economic background!
    I hate this political posturing.... that’s for public health or MPs!

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  • Well written article, agreed social media, celebrity culture, narcissism and th passivity of our consumer role within global capitalism are sources for much unhappiness. A general lack of spirituality and the increase of the concept of the individual as opposed to collective of society are damaging self worth. Disintegration of family structures puts a strain on many people.

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  • Agree, it’s a well written article and seemingly from an informed and caring professional BUT it does come to a bizarre and tired conclusion.
    GPs are primarily medical practitioners and dumping all of society’s woes on us has already more than decimated our ranks.

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  • I agree with the author. Societal problems lie outside my realm of influence. No chance of sorting these problems through the prism of medicine.
    Christopher I think is wrong, didn't Greenspan manufacture the 2008 financial crash because he followed Freidman?
    I suspect people who follow Jordan Petersen are less happy than those who don't. He's not an economist.

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  • No, Friedman doesn't advocate a completely free market, but a minimum state presence to prevent/punish corrupt practices (which is what caused the crash). That's the line I draw for state intervention - to intervene when someone infringes upon the rights of another, i.e. policing, border control, judiciary.
    Why do you think people who follow Jordan are less happy than those who dont'? I'll tell you, it's because there is a lack of emphasis on personal responsibility in today's society, and it is responsibility that gives life meaning. Happiness is a lousy goal to have in life, especially short term happiness. Getting high makes you happy for a bit. And why do you think he's so popular? Because his followers are HAPPIER when they take his advice. No Jordan is clearly not an economist, but he is a clinical psychologist, a rare conservative one too, but most importantly, the foremost advocate today of personal responsibility and how to sort your life out. He's also a critic of totalitarianism, collectivism, post-modernism, those who oppose free speech.

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  • Good article. In society we have decided that depression and anxiety are medical problems. For the vast majority there are significant environmental factors contributing (as you say in the article). And yet, in the mindset of the public (and many doctors), depression is a problem within the individual, that a doctor must solve. So often in consultation I am thinking "I understand that life has been hard. Why, oh why, is this a doctor's problem to solve?"

    Patients will, with no hint of irony, explain the list of contributing factors in their life, and STILL Believe that the problem is within them, or that a pill will somehow allow them to be happy with their horrific lives without being depressed by it. Time and again, we are told to "seek help" if we are depressed, as if some external agent (usually a doctor), can somehow modify your life resulting in "cure".

    I think we have got the approach really, dangerously wrong. I think patients get value from a caring doctor, because we bring some kindness and relief in to their lives. That's great, but, I think, a waste of resources and a backward approach. We've a long way to go.

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