First, a disclaimer. I am not writing about serious psychiatric conditions. They exist, we still treat them as if they had stigma associated with them, and the NHS is overwhelmed and has been for years by these serious illnesses.
But there is another level of mental health, affecting particularly the young, although by no means exclusively. We appear to have medicalised anxiety in all its forms, creating a situation where a normal range of worry, associated with everyday living, is perceived as a mental health question, to which there is no easy answer. It’s not helped – indeed it is vastly exaggerated – through the toxic environment of antisocial media, amplified to a deafening pitch by trolling and other plain nastiness.
The internet, which ought set us free, in too many places enslaves us, pushing many beyond mere anxiety, toward the cliff edge of depression. I have to say that I believe the wisest words written on depression in the past 400 years come from Robert Burton. He called it melancholy penning his thoughts early in the 17th century. A lifelong sufferer, after exhaustively examining every ancient and modern text on the subject, he simply and pithily concluded: ‘be not idle, be not alone’.
Quite.
However, there is always ‘official’ therapy (which I have indulged in, from time to time in the past; not any more, my therapists, should I need any, are my spouse, my personally defined ‘family’ and friends (in that order).
As for the rest, here are a few thoughts, hints and tips.
Therapy takes a long time
TRUE and FALSE
First, ‘therapy’ isn’t one thing; the British Association for Counselling and Psychotherapy lists 33 approaches. ‘It’s so broad that it would be like saying “engineering” – when there’s chemical engineering, civil engineering, AI engineering,” says Susie Orbach, the author of In Therapy: The Unfolding Story, who comes from a psychoanalytic background. ‘I’m ancient now, so I don’t take anybody on for long-term therapy any more – but you can make fundamental changes in a short time.’
Everyone needs therapy
FALSE
Celebrities may give the impression we should all be ‘in therapy’ but not all experts agree. Orbach believes that, as a society, we need ‘to have more emotional literacy, ways of thinking about how we connect and disconnect, and manage difficulties, sorrows or pleasure. But I don’t think everybody needs therapy.’ Coaching and counselling psychologist Prof Stephen Joseph, author of Think Like a Therapist, remarks that everybody benefits from personal growth, ‘but you can find that in various ways, from reading books to watching the sun set – therapy is just one’.
It’s all your mother’s fault!
FALSE
This characterisation has (arguably mangled) Freudian roots. It’s the concept that your early mother-child relationship is the prototype for all future relationships – but it raises a wry laugh from virtually every therapist.
Orbach describes this deep-seated stereotype as ‘inelegant’ and explains that ‘therapy is useless unless it puts the parent in their own social and psychological context. Blame doesn’t help – understanding helps, about limited capacity or notions of what it meant to be a child in that moment in history.’ Or: ‘Reviewing your history is a key part of getting to know yourself better. What you learned as a child provides clues for why you act and think as you do now, but it’s not about blame.’
Therapy is expensive
TRUE and FALSE
It’s available free on the NHS, and you can self-refer, but there are long waiting lists. Orbach says: ‘Therapy on the NHS has been cut back and cut back, and people have to be paid for the work they do, the office they rent, the insurance they pay and the training they’ve gone through, so it’s expensive.’ Cost will vary by the type of therapy and location, but a session will probably cost between £40 and £100.
However, Local Mind organisations offer therapy from as little as £12.50: https://www.mind.org.uk/about-us/local-minds/
Therapy is hard work
TRUE
Therapy isn’t passive, it takes an effort. People think it’s like seeing a doctor, and they have a treatment to make you better, but therapy is about learning to be ourselves and we do that in our own way, at our own pace, so it’s as much work as we put into it. It should be an adjunct to normal life, it should never be overwhelming. You can compare therapy to physio – if we do the exercises, we make a good recovery. To create change, you need to do the work with your therapist and maintain that in the long term with or without their help.
Therapy will fix your problems
FALSE
Most humans want to do whatever we can to get rid of distress, and therapy gets equated with that. But it is actually about helping you understand a problem – where it started, what keeps it going, what makes it better or worse. Expectations matter. It’s not about ‘fixing’ but improving. Any person who is expecting their partner to hold them all the time or to regulate their emotions – that’s not possible; it’s about being more aware, more empathic, listening to one another, knowing one another more deeply – and in that your relationship can really improve.
You can become dependent on a therapist
TRUE
If for the first time in their lives somebody feels listened to and understood, they could put this relationship up on a pedestal. But rather than this being a problem, a good therapist would see that as something to explore.
Therapy makes you revisit trauma
FALSE
Worried that therapy is about sifting through your darkest moments? Not so: a decent therapist will happily sit with you in relative silence for an hour, rather than make you talk about anything, and many therapies are forward-looking, focused on living in a more flourishing, positive way. Therapy is also very much about seeing your strengths, noticing things that are already in your life and building your relationships. It’s about getting people to a better place, or seeing themselves in a better way because when you’re going through a hard time, you can lose that.
You’ll have to talk about embarrassing things
TRUE and FALSE
People are drawn to explore things to make sense of them, so they will – very slowly – move towards talking about things that are uncomfortable. But that happens only because people feel in a safe, supported environment. The things that we can be shy about can be really tiny, but it’s so tender for that person, so you do talk about things that you’ll have reluctance to talk about. This idea that these things are awful or shameful pulls us down, so bringing them out in the open can really help.
Therapy is a branch of medicine
FALSE
The idea that therapy is a place where people go to get cured of their illness or disorder is a deep-rooted cultural myth. Better to say it’s a form of education, a place where people learn to be themselves. Culturally, we don’t talk about problems until we literally don’t know what to do and then someone might say, ‘Go to the doctor’, which is where sick people go. Then the doctor refers you to a psychologist, so all the subliminal messaging is when we’re not doing well, there’s something wrong with us, as opposed to this is just what it means to be human.
Addiction can be overcome, says John Crace
He wrote last week: ‘Barring any last-minute relapses, tomorrow (March 9) will be the 37th anniversary of my getting clean. No drugs, no alcohol. I call that a result. I had no idea what I was doing really when the 30-year-old me walked through the entrance of the rehab centre on the morning of 9 March 1987. I had even brought a cassette player and some tapes with me because I imagined I might get bored.
‘Those tapes never got played. The cold turkey was hell. I have still never forgotten it. Ten days of almost no sleep, shitting and vomiting while the counsellors tried to coerce me in group therapy. But I had one thing going for me. I knew I had hit rock bottom. That I had no more using left in me. I was overdosing at least once a week and I knew that if I didn’t stop I would be dead within a year. And for the first time in years, I cared more about living than I did about dying. So I stuck it out.
‘After leaving rehab, I went to Narcotics Anonymous meetings where it took me ages to say a word. My brain was still too scrambled to take charge of my thoughts and construct coherent sentences. Family, friends and fellow recovering addicts looked after me when I couldn’t look after myself. I owe them my life. Many of them are now dead. Addiction is attritional. Relapse, suicide, Aids, hepatitis C, cancer and heart disease have taken their toll. There has been a far higher incidence of serious illness in recovering addicts than in other friends. But those who survive, I love dearly.
‘It hasn’t been easy. No one becomes an addict because they are well. I have struggled with depression and mental illness; twice been admitted to a psychiatric hospital. But I have plodded on, a day at a time. Because what else am I going to do? I have never had a plan. Other than not using. I only became a writer because a friend was a writer and it seemed there was a possibility of a freelance career without having to explain a 10-year gap on my CV. So here I am. Somehow, I have built a life. A beautiful wife, two wonderful children and a gorgeous dog. I am a lucky man.’
This week: Tim started to read On Growth and Form, by D’Arcy Wentworth Thompson, first published in 1917. Thompson was a true polymath; the story is that he was offered three chairs to choose from: classics, mathematics, zoology. On Growth and Form is an elegant amalgam of all three fields. He discusses the mathematics of growth, proving that there are both simple and complex maths involved in why living things, from Amoeba to Oak Trees, from jellyfish to dinosaurs, take the shape they do. The text is apparently on the reading list for architects to this day, and Thompson shows the precise relationship, for example, between a stegosaurus’ skeleton and the structure of the Forth Bridge. Fascinating, and although written with great erudition and elegance, you’ll need your Greek, Latin, French and German dictionaries. Many of his quotes remain in the original language. You also might need to brush up on Euclidean geometry!