83. Bandwagon for sale, very low mileage.

A concrete windswept piazza, early in the morning, before the philosophers arrive.

I tried to warn the Liberal Democrats about the negative halo effect that occurs when anyone talks about mental illness in the media. As soon as the talk gets round to mental health, people become upset and change channel, without even knowing why. Not only that but they get grumpy and choke on their pop tarts. The reaction is deeply intuitive, like a brain stem reflex.

The Libs banged on about mental illness affecting one in four of us and needing to be put on the same footing as physical illness services, eliminating suicide etc, just as though they hadn’t read this blog. They didn’t listen and now they are a burned out ruin on the hard shoulder of politics.

Though the halo effect has been known for more than 50 years, this has not stopped a succession of doomed public awareness campaigns such as ‘defeat depression’.

We know that mental health information is perceived as toxic, but no-one has adequately explained why.

Since Shirley Star’s studies of public opinion in fifties USA, the consistent findings have been that people with mental illnesses are regarded as dangerous and unpredictable. Presumably, so too are violent criminals, but they get massive media coverage and scrutiny. Most likely, the ingredient that puts people off dealing with mental health is having to try and understand it. Once you start to think about it, even if you’re in the business, there’s a large parcel of mental work to be done before you can process the information.

For instance, drawing the line between unhappiness and depression, separating personality disorders from illnesses from disabilities, let alone facing the mind brain problem. We’re pretty quickly into Melvyn Bragg territory, but without his panel of expert communicators.

It’s exactly the same for other specialists. A motor mechanic recently tried to explain to me – in some detail – about what had gone wrong with the car’s air conditioning. I remember the phrase ‘wobble plate’, but to be honest that’s the only thing I can tell you about it now. I’ve had to abandon any smug pretensions to knowing my way round a Compressor. Though I will, soon, find an opportunity to say the words ‘wobble plate’, somehow or another.

I’d compare the negative halo to the effect of encountering a protest demonstration in a shopping centre.  First instincts are to avoid it, not particularly in case of violence, but more in case you are called upon to examine a complex issue, like whether a remote area of a foreign country has been shabbily treated. Thinking is the last thing you want to do in the Arndale Centre. But it’s the kind of thing you might do by listening to Radio 4 at about 8pm, alone in your car on a smooth stretch of highway. But then that’s your choice, if you’re in the mood for mental activity.

Outside the police station, a large sign reads PRIDE. I’m going slowly enough to recognise that PRIDE is an acronym – after each capital letter is a smaller word. Subliminally, I perceive the words to be: Pride, Respect, Integrity, Dedication and Empathy. Are these virtues (or sin, in the case of pride) really top of our list of desirable qualities in a police service? Surely, these are not the words you want to hear when the machetes are waving and the AKs start popping.

Having said that, I’ve had no success in weaving an acronym from the words, Taser, Cuffs, Tear-Gas, Smith, Wesson, Court and Prison.

Doubtless the police have their reasons for presenting themselves as social workers, such as the diminished number of real social workers. And obviously they have to try and maintain the moral high ground. Nevertheless, my brain stem reaction to the PRIDE sign was: misguided PR campaign. People are proud of the police because they stand up to horrible people, not because they are empathic. Bad Boys 3 will not be subtitled Good Boys.

The negative halo effect cannot be countered by dressing things up. On the contrary, we are set on guard most acutely by any hint of deception. Very large and fast neural systems are devoted to spotting trickery. It takes a lot of considered reflection to counteract such defences, which means weighing things up carefully. The very thing that stresses out the wobble plate.

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2. Where will the war take place?

The war against Depression begins with an attempt at building a strategy (unlike some recent wars I could mention).

Firstly we must identify the enemy. Then we must identify our resources. Then we must deploy our resources to where the enemy is weakest.

And we must look at where previous similar campaigns have come unstuck.

A few years ago, the UK Royal Colleges of Psychiatrists and GPs ran a campaign called ‘Defeat Depression’. Traditional campaigns designed to improve public health usually involve screening – trying to detect cases of the illness that have not been discovered. For a successful campaign the following ingredients are needed:

We have a way of discovering cases using some kind of test.

We have a treatment option to offer those found to be suffering.

The treatment option is effective enough to cover the costs of running the program.

The Defeat Depression campaign was based on the notion that a large number of depressed people were undiagnosed and suffering in relative silence. If they were diagnosed, using simple screening tests, they could be given antidepressants and/or therapy that would improve their condition.

Recent types of antidepressants such as selective serotonin re-uptake inhibitors, (SSRI) seemed to be effective, non – addictive and low in side effects. So the balance had tipped in favour of prescribing them, if not exactly spraying the countryside with them.

Sure enough, there has been an enormous increase in the diagnosis and treatment of depression in  the UK. GPs use a screening tool called PHQ-9 to uncover cases. For moderate or severe depression, antidepressants are recommended, starting with an SSRI, either Fluoxetine (Prozac) or Citalopram (Cipramil).

Possibly, one day, SSRIs will become ‘over the counter’ remedies rather than prescription only. After all, you can now buy own – brand Ranitidine at hardware stores. Its not that long since Ranitidine was ‘Zantac’, and available only from proper doctors in white coats and half- moon glasses, probably after an endoscopic exam or barium x ray.

People used to warn that taking Ranitidine might mask the symptoms of more serious stomach problems, delay people seeking medical advice, and thus prove harmful. Such fears seem to have been overly pessimistic, but doctors and pharmacists are always going to want to steer the medicines trolley.

Making antidepressants freely available in Lidl, or Boots at least, might have a greater impact than any other measure, if we are seeking to get the greatest number of people on to antidepressant medication. Yet there has been no campaign to make this happen. Why?

Is it because antidepressants can be harmful if not carefully monitored? For instance they need to be taken for several weeks at least rather than as and when we feel like it.

Or is it because we are reluctant to see medication as the answer to Depression? Or maybe because existing antidepressants have a relatively poor benefit to risk ratio?

The defeat depression campaign attracted a fair amount of criticism behind the scenes. On the one hand there was something of a doubt over how effective antidepressants really were.

Also they had side effects that were troubling, some real and some imaginary. It was suggested that they could make some people more impulsive and – in the case of teenagers – more suicidal. Some of them seemed to have ‘discontinuation effects’ causing flu like symptoms a day or two after stopping treatment. Their effect of reducing libido was more common than people recognized.

People warned that the Depression concept was being stretched to include unhappiness, ‘medicalising’ peoples responses to social ills such as call centres and poor quality sausages .

Some people even went as far as suggesting the depression industry was part of a capitalist conspiracy to make people feel dissatisfied with their lot in life. It was alleged that such dissatisfaction would serve to fuel consumer demand and get the proletariat back on the treadmill of purposeless consumption, indebtedness and hard labour.

In the background, a few psychiatrists remained highly skeptical about the effectiveness of newer antidepressants, even preferring older drugs that had a better evidence base.

It looked to many as though the Royal Colleges had been swept along by the SSRI companies, without thinking the strategy through. Two favorite stereotypes for Psychiatrists are Dr Dippy and Dr Evil. So, not looking clever, and seeming to be in cahoots with drug companies, damaged our image. When the Prozac bubble burst within the liberal consensus, British psychiatry was badly splattered.

The most deadly germs are those that can change their form and structure. The same is probably true of terrorist organizations. By adapting to different situations they can often go undetected. Germs can pretend to be other organisms, or part of your own body.

Terrorists can pretend to be religious men. Gangsters can pretend to be politicians.  A lot of it is down to packaging and presentation. Depression is an entity that resorts to camouflage in response to a conventional attack.

In response to the Defeat Depression campaign many people remained in denial. Few were convinced that Depression could be treated in the same way as a germ based illness. Few were convinced it was easy to identify and treat. And even fewer trusted psychiatrists and GPs to tackle the problem.

Lots more antidepressants were finding their way into our sewerage systems one way or another, (often cutting out the middle man), but was anyone much happier?

There is a lot of conflicting thinking about Depression – whether it exists within society, and whether it exists in an individual. It can hide within a heap of what looks like unhappiness. It can hide within what looks like a life crisis or drink problem. It can hide within a cranky view of the world.

Essentially, all this needs to be tackled on a personal level. Depression exists in individuals, not in towns or countries. All that matters is what Depression means for you.This means that the battle against Depression will take place mainly in your kitchen. Luckily, you choose the weapons.

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At exactly 0600 we go over the wall.