Helen Razer: “Mental illness does discriminate, but not in the way Latham says it does”

via Razer on Mark Latham’s Harden Up prescription for the depressed chattering class | Daily Review: film, stage and music reviews, interviews and more

This past weekend, Mark Latham gave his fortnightly column in the Australian Financial Review to critique of the movie Birdman. As a connoisseur of the contemporary lens, the former politician falls just a little short and would perhaps be better simply smashing cameras than waiting around for them to disappoint him. It is difficult to agree with his brutal assessment of a work that has been hailed as a career-defining Hamlet for its director and trickier still to allow his view that this is a movie about “mental illness” as it is presently understood. It is not so much a contemporary and realist “mental illness” that we see unfolding in Michael Keaton’s Birdman but an old-fashioned and metaphoric madness. This is not a movie that explicitly urges understanding of the mentally ill but one that implicitly urges impatience with those delusions produced by fame and power.

Still. It’s difficult to come up with column ideas outside the general range of “Everything that Keating Did Was Marvellous” and so, Latham has seized upon this half-opportunity to revisit one of his observational standbys, “The Chattering Classes Are So Bored With Their Keating-Produced Prosperity, They Pretend They Are Mentally Ill”. Latham presaged this idea of mental disorder as a bourgeois indulgence when heclaimed last November that the honest, hardworking women of western Sydney have no neuroses. Mood disorders and post-natal depression, he said, were an imagined accessory of an indolent middle-class. Who, presumably, should just honour a photograph of Paul Keating and Jack Lang framed in a valentine as a therapeutic measure instead of “popping pills”.

I imagine the ALP has already begged Latham to stop campaigning for Lindsay. Perhaps they should also remind him that there is a very clear and persistent national and international correlation between mental illness and poverty. The merest interrogation of statistics on mental health would upturn the link between income and social inequality with depressive illness and bury Latham’s queer entitlement to tell us all to Harden the Fuck Up. To be clear, it is those who suffer social and economic isolation who are at the greatest risk for mental illness.

Of course, Latham has been served this argument in recent days. Well, select non-economic parts of it, in any case. As this review of popular opinion indicates, the objection to Latham’s brutal dismissal of mental illness as a middle-class fantasy generally proceeds, “but it’s real and I feel it”.

Between this popular view that “mental illness doesn’t discriminate” and Latham’s unpopular view that it is a largely imaginary thing that is itself a sign of middle-class discrimination, there is, perhaps, another way to address what results in impatience on both sides. And that is by looking a little more arduously at the history of mental illness and its present function. And conceding that one or two of the things that Latham has to offer are, in fact, vaguely legitimate.

Mental illness does discriminate, but not in the way Latham says it does. It disproportionately afflicts Aboriginal Australians, prisoners, women, homeless, low-income earners and others who experience social and/or economic exclusion. This is not to say, of course, that some of the well-to-do beneficiaries of a Keating economic agenda do not suffer from what we call mental illness. It is, however, to urge that in the utilitarian context of policy discussion, services and solutions must be found for the social groups who need them most and can access them least.

It is here that we can entertain a partial understanding of Latham’s disgust for a mentally unwell middle-class that relentlessly examines its own disquiet by means of prevalent feelpinion. There is not a week in publishing that passes without some popular self-outing by a middle-class sufferer of mental illness who is extravagantly thanked for “starting the conversation” and “ending the stigma”.

The obvious problem with personal works on mental illness by the media class is that they contribute to the assumption that “mental illness does not discriminate” and so do little to urge for discriminating solutions delivered to the people and regions who most broadly need them. The less obvious problem is one of false enlightenment. With every middle-class confessional of mental illness — and this is not to say that some of them are not both very well-written and well-intentioned — we convince ourselves that here is a truth hitherto ignored. And, conversation about mental illness is not ignored. It’s just a little ignorant.

If Latham is annoyed by anything, it is perhaps the constant act of false revelation. I am absolutely sure that the frequent personal writing andbroadcast on mental illness is produced by people who suffer. The personal disclosure is not false but what is false are the ideas that (a) no one talks about mental illness and (b) talking is a way out of mental illness.

It is absolutely true, of course, that the talking cure is one legitimate means of addressing mental illness. But the technique pioneered by Freud to unfold between therapist and patient was never intended to play out in a public context. As the methods of psychoanalysis have been largely abandoned by the medical profession and replaced by Latham’s “pill popping” — and in this case, he’s right. More than twelve million prescriptions for anti-depressant medications are written in Australia each year — it has been taken up by media.

The act of taking an intimate methodology into a public forum is not only one that is potentially dangerous — the act of continually baring oneself or comparing oneself to others is a terrible stand-in for truly unfettered conversation with an analyst. It allows the individual experience — in this case, the middle-class one that grates on Latham — to become a metaphor for all experience and it individualises the response to a widespread social program.

Organisations like beyondblue constantly chide us that the lack of individual understanding prevents people from accessing the care that they need. If only everybody truly understood mental illness, so the reprimand goes, it would be far less of a problem. People would go and seek care and doctors would dispense it more effectively.

While it is true that it is very unpleasant to feel misunderstood while in the grip of a mental illness, it is also potentially true that mental illness in the terms it is broadly and compassionately discussed is itself misunderstood.

Even if we find no scintilla of agreement with Latham that the middle-class commentators on mental illness are “faking it” and indulging in a fantasy of oppression in the absence of any other enemy, we can perhaps agree that mental illness is a troubling category. And one that has become very one-size-fits-most.

From the time of Hippocrates, there were two distinct definitions of “melancholia”, or what we would now call depressive illness. There was that which arose with cause and that which arose without. Some people had reason to be sad and some just had bad “humours” working within them.

This is a distinction that was all but erased in 1994 with the fourth revision of the Diagnostic and Statistical Manual for Mental Disorders (DSM). This blockbuster of the American Psychiatric Association, which influences mental health care in the west more than any other publication, took sadness from its social context. Whereas once one’s depression could be seen as “reactive” and the result of divorce, job loss or the physical diagnosis of a critical illness, it now became a category with none of the Hippocratic distinctions. In 1994, there was a single exception for the diagnosis of depression, now able to be “treated” with a new site of anti-depressant SSRI category drugs, and that was bereavement. In the fifth revision of the DSM published in 2013, grief was removed as an exception. Actually, bereavement itself was medicalised. And recommendations for its treatments with a new suite of anti-depressant SNRI category drugs was recommended.

We believe that our personal understanding of mental illness drives recovery when, in fact, it is a codified understanding of mental illness that is driving us. We live in an age where many human foibles become matters for medical discussion. If you eat and order a pizza once a week, you now have, according to the DSMV, Binge Eating Disorder. We live in an age where many logical responses to social and emotional hardship become loosened from their real world moorings and become depression or anxiety.

This is not to say, as Latham does, that sadness or worry once understood as ordinary should not be treated. Nor is it to champion his obscene claim that economic growth means that Australians should feel no sadness. The GDP is not a measure of the social inequality that afflicts many Australians and can result in the diagnosis of mental disorders. It is to say, however, that the fundamental Hippocratic division between moods that are the result of injury and moods that are the result of disease urgently needs to be restored.

This counsel for a more nuanced, and more legitimately scientific, understanding of mental disorders is not just some lay whining. It is the work of eminent theorists in the field, including the now repentant editor of the DSMIV, Allen Frances. Frances, along with respected American psychiatrists Horwitz and Wakefield and local child psychiatristProfessor Jon Jureidini are among those impatient for reform that understands both the social and biological influences in what we call mental disorders. In hopeful recent news, the US National Institute of Health has attempted a transformation of diagnosis by announcing its intention to study the neurochemical factors which may produce “bad humours” in its new research criteria.

Psychiatry is, at present, largely a case of very bad science. There are no blood markers or brain scans in psychiatry. There are just a lot of drugs. And these drugs are administered on the basis of self-reported symptoms and evolved with no regard for how they might affect a patient who has a reactive depression as opposed to one who has the yet-to-be-discovered neurochemical kind. And it is this economically motivated scientism that informs the “understanding” we urge in all the feelpinion pieces that Latham despises.

Latham despises these pieces for entirely the wrong reasons, of course. His disdain for middle-class women as vessels of prosperous indolence, and not Keating ideology as he would prefer, is plain old crusty Labor sexism where ladies are surplus to the production of the dutiful masses. Further, his insistence that this understanding is a “left wing” agenda when it is plainly conservative is a logical balls-up. There is nothing more right-wing than saying, as Jeff Kennett does, that mental illness is free from social influence.

But, this is what most people are saying. We have accepted the economically created fiction that mental illness is a democratic affliction. Because “anyone can get it”, the social specificity of certain experiences — say, being black and in prison with a limited life expectancy — is seen as indistinct from middle-class ones.  This ideology works to convince ourselves of the bullshit that We Are All One when we are not at all “one” in terms of social and economic equality. And it also has the very real impact of shackling research into mental illness. When we all become “one” scientifically and the criteria is only “do you feel bad?”, science is bound to draw false conclusions.

Latham, of course, draws false conclusions. But, so do many of the respondents to his revulsion for the current social and medical approaches to mental illness. We can all agree perhaps, that large numbers of people need help. The fact that this help is restricted scientifically and ideologically by the idea that “mental illness doesn’t discriminate” is perhaps the real tragedy in this debate.

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