82. Euripides Trousers …

OLYMPUS DIGITAL CAMERA

Bees. They just get on with it.

Up until recently being a teenager was not regarded as a mental disorder. After David Cameron urged us to hug a hoodie, teenage angst was virtually eradicated from the  diagnostic landscape.  But now, some people seem to want to regard teenagers not just as sad victims of poor trouser design, but as Patients.

Someone’s looked at the lyrics of The Kids are Alright by The Who and recognised that they really meant the opposite. The Times is running a campaign about children’s mental health. A lot of assertions are being made that children are unhappy, that they are living through unusually stressful times, that they are victims of the modern world.

Horrible articles are being written about teenagers, suggesting they are unfathomable monsters and the National Theatre is running Medea again. I’m sorry, but this children’s mental health campaign feels like a moral panic. Who is stoking it up, and why?

Somehow or another, ‘subjective well being’ has become confused with becoming mentally ill. I’m a hypochondriac, but does that really affect my chances of getting ill?

Here’s a test of your subjective well being, the one used by the Children’s Society, the people who gave us the christingle:

Here are five sentences about how you feel about your life as a whole. Please tick a box to say how much you agree with each of the sentences: My life is going well; My life is just right; I have a good life; I have what I want in life; The things in my life are excellent.

Subjective well-being is arguably a test of how smug and complacent people are. How would John Lennon have scored? How would we have wanted him to score?

Before we go any further, how desirable is it for everyone to think the things in their lives are excellent?

Children are apparently scoring worse in such studies since 2008. And UK children are being dragged down the international league table by girls’ concerns about their appearance. British girls are second last, only South Koreans scoring lower, despite their excellent android phones.

It’s election time, so Nick Clegg is using the present tense when he should be using the future subjunctive, which apparently exists in Spanish. He’s claiming that stuff is happening, like expanding children’s services, that just might happen one day but probably won’t. He is comparing children’s mental health services to cancer services. If doctors did that they’d be accused of an absurd fixation with the medical model.

Libby Purves, still top of my list for head of state once we become a republic, compared children’s mental un-health to cholera, though admits that there is ‘no single pump handle’ to sort out.

To Libby’s credit, she soon recognises the problem is not like cholera at all.  She blames children’s unhappiness on: divorce, drug use, exam anxiety, peer pressure, early sexualisation, information overload, loss of contact with nature, ubiquitous screens, TV, games consoles…

Just like our generation suffered so much from CDs and colour TV. Just like our parents generation was thrown into abject misery by antibiotics and Walt Disney.

And she goes on to suggest a list of practical solutions: a smartphone ban in schools, art classes, choirs, safe outdoor spaces, park keepers, bus conductors, beat coppers and finally, ‘volunteering and youth groups to be made fashionable and fun’.

No doubt Libby is on the right track in terms of placing the issue firmly in the Sociology Department. There’s a squeeze on social capital and no sign of quantitative easing. That’s not to say that useful modern inventions like apps and text messaging are deleterious to social capital – quite the reverse is true judging from the queues in Costa and Macdonalds.

Very soon, the children’s mental health campaign will have to contact Blur to see if they can borrow the slogan Modern Life is Rubbish. But remember, that album was released in 1993, which to the under 18’s is somewhere between Roman times and Wolf Hall. Modern life really was rubbish then, before graphical user interfaces and flat screens. And it was probably rubbish in 1893, the year when the US Supreme Court declared the tomato officially to be a vegetable.

And isn’t the rest of The Times newspaper filled with all the stuff that Libby regards as a cholera fountain? The cholera in question being market-driven, intra-sexual competition. There’s a lot of stuff about girls who hate themselves and almost nothing about bus conductors or park keepers. In the fashion section all the items are unfeasibly expensive apart from one token item from Primark. Any article about anything whatsoever, such as which is the best digital tyre pressure device, will be accompanied by a picture of a thin female person, probably one of the tiny girls employed to make the DFS sofas look massive. If Libby finds that pump handle she ought sort out some of her co-workers with it.

People have been casting aspersions on younger generations throughout history. This is perhaps the first time that teenagers are being castigated by being labelled mentally unhealthy. It’s a change from being considered morally deficient or stupid, but just as fatuous.

Mostly, there is no sense in medicalising the problems children face. There are no specific treatments or therapies that will help them and no army of skilled professionals waiting for Clegg to deploy them.

Luckily, there is little evidence that youngsters are any more mentally unhealthy than any other age group. Mental illness, like most other illnesses, gets more likely when people get older, like rust on cars. Children don’t get mentally ill in the same way as adults, not very often anyway. Although it is unbelievably awful when a suicide occurs in a young person, teenage girls’ rates of suicide are three time lower than middle aged women and twenty times lower than middle aged men.

People are not growing huge thumbs as a result of texting or walking into traffic because of ear phones. A teacher asked me recently whether schools should have mindfulness programs. But surely, a school is a mindfulness program?

Attempts are being made to impose guilt on schools and companies for being competitive, with the aim of selling them mental health services to patch up any bruised egos. The Times is doing something similar within its internally contradicted hand-wringing departments of greed and anti-greed. Thankfully our children our savvy enough not to join the stampede down to CAMHS.

Anyway, they can’t run in those trousers.

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1. The War on Depression Starts Today

Car parks can be beautiful if you look at them the right way

 Don’t be frightened – it’s only a car park.

 

The War on Depression: where is the enemy weak?

These pages are mainly about Depression. The starting point is to understand how Depression comes about and the finishing point is dealing with it better.

As an individual psychiatrist it may not be possible to make much of an impact on the wider problem of Depression, which affects so many millions of people.

But there are many fronts to fight on, outside the hospital.

There are a few themes to these pieces. One is to do with how toxic modern life has become. One is to do with how the mind works and in particular how people make choices. And a third one is to explain how health systems such as the NHS operate for (or sometimes against) people with mental health problems.

However we regard Depression, as an illness, as wear and tear, as a reaction to loss or as a social barometer, there is always another perspective to take.

Rather than ask the question, ‘why do some people get depressed?’ we might just as well ask why everyone isn’t depressed all the time.

Lets get the bad news out of the way right now: people get older. Generally when they get older they get more ill, and (don’t say it, please) eventually die.

In some ways that fact, the D word, is a potential party – pooper, even when we are young and have a fabulous future to look forward to.

Worse than that, even younger people can get ill, and they certainly can be subjected to terrible events (such as school).

Its been said that all political careers end in failure. Partly that’s because of the scoring system in politics, which tends to be ‘sudden death’, either by way of an election, or by way of sudden death.

But the same is not true of most sportsmen and women, who are somehow able to retire at the right time. In boxing, that’s while the brain is still working. For the rest of us, its a matter of recognising changes and adjusting to them .

If we adjust too much too quickly we are hypochondriacs and wimps. If we adjust too late we are foolhardy and in denial.

Life is very complicated and dangerous and a lot of us don’t make it, either in terms of quality or quantity of life. Some of us spend a lot of time ‘off the road,’ on the hard shoulder of life, but that doesn’t make us burned out ruins.

In seeing Depression as a wear and tear or stress related illness, we are not really explaining it very much. I prefer to see it as a natural phenomenon that is also an enemy, like rust. Or, at times, Gravity. Black ice. Wind. Electricity. Biscuits. Etc

All necessary but dangerous when out of control.

Depression happens when the system that controls mood is defective. The system has failed to calibrate correctly, or feed back on itself, or stay at a level. Most of what we do in treating Depression, one way or another, is to try and get the control system working better.

Often that’s a matter of seeing the situation differently: reflecting, reframing, resetting, recalibrating. (4 Rs. Much better than 3.)

The way we see Depression, in its widest contexts, affects very much how we deal with it. Depression is a very isolating experience, both in terms of reduced social contact, and reduced range and quality of thinking.

But if Depression was inevitable, or even an overwhelming likelihood, why is it that many people never get depressed, whatever happens? Do they have a very sophisticated chemical control mechanism? Or do they reflect upon the world in a different way? Or do they have some protective factor, like a guardian angel?

After this length of time, over 50 years of antidepressant and drug therapy, it doesn’t look as though we have a breakthrough solution, at least by way of a tablet. It would be nice to think a magic bullet would get discovered, much as saltwater killed the Triffids in one of the Day of the Triffids films, or the Common Cold killed the Martians in War of the Worlds.

While we wait to find the enemy’s weak spot, we continue to fight on all fronts. Depression’s Achilles Heal is in fact the thing that makes it strong, its incoherence as a diagnostic concept.

Could Depression fall apart under the weight of its own complexity, like the coalition government?

More to follow.