The day I could no longer get out of bed to go to work as a psychiatrist was one of the worst days of my life. For several months I hadn’t been sleeping, couldn’t think clearly, had lost weight, felt exhausted and physically ill, but I’d pushed myself to continue until I finally broke down. My world was caving in on me and thoughts of suicide had seeped into my mind. Everything was hopeless. Like millions of others every single day, I was suffering from depression. I knew that because I’d treated many, many others with the same illness.
Depression is not a ‘normal response’
Nearly one in six people in Britain will experience depression in their lifetime, and it’s twice as common in women as men.
It also kills.
People suffering from it have 30-times the normal risk of suicide. Depression isn’t just ‘unhappiness’ it is an illness that takes over your daily life and prevents you from functioning. It comes in many forms – from the awful, anxious agitation that I experience through to frank psychosis and from milder despair to severe, dark, horrible, speechless melancholia.
However, currently there is a vociferous movement made up of critics of psychiatry, including a very small number from within the profession, who take a different view.
They deny depression is an ‘illness’ and see it as simply a ‘normal response’ to a difficult life. Not surprisingly that’s a very attractive message both for the right-wing bandwagon that wants to cut public spending on mental health, and a government seeking to reduce the cost of Department for Work and Pensions (DWP) sickness benefits.
Fuelling DWP agendas
Last spring, the then-work and pensions secretary Mel Stride said that ‘people with depression or anxiety could lose access to sickness benefits’. By January this year, the headline from the Telegraph said:
More than half a million claiming disability benefits for anxiety and depression: government faces growing pressure to solve worklessness crisis as welfare claims soar since lockdown.
This coincided with the report Change the Prescription from the Centre for Social Justice (CSJ), founded by former work and pensions secretary Iain Duncan Smith. The report informed us (without guidance from epidemiological experts) that “the line in psychiatry for when distress becomes mental ill health is subjective” and “misunderstood mental ill-health is the leaky bucket draining the nation” – whilst further citing the wisdom of prominent critics of psychiatry.
Add in Tony Blair telling us all not to “self-diagnose depression” (how can you not when you can’t see a doctor?) and psychiatry critic professor Joanna Moncrieff, in a recent interview in the Times, widening her critique of antidepressants to include the apparent inadequate willpower of those of us who suffer from depression too (“making changes in your life is difficult and scary, so of course it’s easier at some level to be told to take a pill”) and you have the perfect storm.
DWP benefits for those who are unfit to work because of anxiety and depression, and other mental health problems too, are under greater threat than ever before.
We all must work instead.
Really?
Systemic misogyny
Given women are twice as likely to suffer it’s hardly surprising that the rise in claiming DWP benefits for depression and anxiety is higher in women. Younger women in their thirties, who’ve struggled through the pandemic as they tried to hold together work, family, and homeschooling, and older women in their fifties, with multiple physical problems too which worsen mental health.
But Liz Kendall thinks too many are ‘taking the mickey.’
Primary care used to help many of these women, but now it’s hard to be seen and continuity of care has disappeared. Waiting lists are interminable. Many will have been unwell for a long time, without the kind of complex care that will help them to recover.
The peak suicide rate for women is age 50-54, and the mean age for the menopause, which can seriously affect our mood is 51. It’s not ‘unhappiness’, it’s illness. We need proper therapy and psychiatric care not workfare and ‘support’.
We’ve been here before
Some remember how, in the 1980s, the antipsychiatry brigade – forerunners of the present naysayers and led by people like American psychiatrist Thomas Szasz who called mental ill health a ‘myth’ – attacked spending on mental health.
His major achievement is what you witness every time you walk through an American city. Severely mentally ill people living on the streets. Forcing people with mental ill health to work is inhumane too. Selecting out those with anxiety and depression to do so will re-stigmatise problems we have been trying so hard to get people to talk openly about.
In the foreword to Change the Prescription, three privileged, older, white, male members of the establishment tell us that:
All of us are subject to variations in our mood. Good days and bad days are a fact of life.
Inequality is a fact of life too where depression is concerned.
As someone who suffers from recurrent depressive illness, I find their and others’ desire to focus on ‘de-medicalising’ mental health all too conveniently supported by those who seem to want to deny its existence altogether. It could result in real harm and suffering, and even more deaths of people struggling with the DWP.
Left to the mercy of the DWP
I returned to work after several months off sick.
I was lucky, I survived, because I had access to good care and treatment and had supportive employers. If I had been left to the mercy of the DWP then I think it would’ve been difficult for me to get through this time and the recurrent periods of depression throughout my life.
Linda Gask’s latest book is Out of Her mind: How we are failing women’s mental health and what must change. It is available from Cambridge University Press here.
Featured image via the Canary
