Introduction: Conceptualising Mental Health in the Twenty-First Century

2016, Beachy Head, East Sussex, England. James, stinking to high heaven, stands on the cliffedge, his eyes fixed on a boat far out to sea. He’s about to step out. He can see a bridge that leads to his personal pirate ship. He shouts back to a woman begging him to stay put. ‘Don’t worry, it’s all going to be okay, Mum. ’

Just down the road, Louise sits in the pub with a shandy to her left, her daughter Jessica to the right. It had been a mistake to bring mum out thinks Jessica. She just can’t stop crying.

Polegate, not far away at all. The child is in school this time. At the back of the classroom this 12-year-old is not listening to the art teacher tell them about using a colour wheel. She’s digging a pencil deep into her arm. Her bag's on the table so nobody else can see.

Dealing with mental distress often provokes anxiety. Little wonder, the stakes can be high, as the authors of this book know only too well from personal experience. We are all trained in the psych disciplines, and one of us is a practising mental health worker. In our personal lives, we’ve had more than our fair share of psychiatrists, psychologists and the kind of severe distress with which we began this book. We’ve sobbed down the phone, begging for psychiatrists to turn up so that people who were a danger to themselves and others could be taken to a place of relative © The Author(s) 2017

C. Walker et al., Building a New Community Psychology of Mental Health, DOI 10.1057/978-1-137-36099-1_1

safety. We’ve demanded psychiatric medication on behalf of loved ones, knowing that it can have brutal side effects and that the evidence base for many of the medications is weak. We’ve lain awake at night hoping that people we cared for hadn’t killed themselves. We also understand why many people are scared of other human beings who struggle to be in control of themselves and who want definitive action, even though a great deal of ambiguity and uncertainty surrounds us when we think about mental distress.

We understand all of this. But we also hold out for different ways of dealing with distress that are more humane than some of the ways that mental health is currently ‘treated’—ways that aren’t tied up with professional aggrandisement and the bolstering of practitioner identities, which go beyond conventional psychiatric and psychological responses. Even pausing for a moment to think about some of the history of such responses here, we are struck by the scale of the inhumane drama involved in the history of treating mental distress, and how in many ways, things don’t seem to be changing all that much for the better.

And yet, in the last 100 years or so the disciplines of psychiatry and psychology have seen radical change. In only 100 years we have seen institutions characterised by the most profound and disturbing male- dominated incarcerations, where husbands had the abilities to admit wives into asylums that doubled as freak shows for paying customers. Such incarcerations could result from such gross indecencies as suggesting that human beings are not born evil, or because husbands wanted a quick divorce, or because wives protested over a husband’s affair with another woman. Reasons for incarceration included infidelity, postnatal depression and being generally disobedient.1

We have lived through the ‘science’ of eugenics where Darwinian thinking was taken to the extreme in the form of many thousands of forced sterilisations to ensure that those considered to be of mentally unsound mind were not able to propagate their ‘defective genes’. We have seen the popularity of trans-orbital lobotomies win Nobel prizes—a practice that involved jamming ice picks into the corner of each eye socket and moving it backward and forward to sever connections to the prefrontal cortex. This practice became so mainstream that Walter Freeman could drive around America in his ‘lobotomobile’ performing lobotomies for $25 a pop (and performing as many as 3439 lobotomy surgeries in 23 states, of which 2500 were his ice-pick procedure, despite the fact that he had no formal surgical training). Indeed, Freeman even lobotomised 19 minors, including a four-year-old child, before it was decided that perhaps icepick lobotomies were not all that they were cracked up to be.2

In the mid-1950s electroconvulsive therapy (ECT) became popular. Formerly known as electroshock, it exists to this day as an inpatient psychiatric treatment in which seizures are electrically induced in patients to provide relief from psychiatric illnesses. Its mechanism of action remains unknown and the guidelines of the National Institute of Clinical Excellence (NICE), the body that regulates what constitutes good medical practice, report that it is beneficial and life-saving for some, and terrorising, shameful and barbaric for others. The antidepressant era began in the 1950s where the predominance of the psychoanalytic model was challenged by the development of a range of new medications, still popular today, which were thought to work on various neurotransmitter pathways in the brain to provide relief from mental distress.

We have also witnessed the growth of the cognitive (behavioural) era, the development of both the antipsychiatry movements and the service user movements as a response to what for many still continue to be dis- empowering, disengaged and deeply problematic methods of social control dressed up as ‘medicine’. At the close of the eighteenth century there were 40 asylums in England and Wales; 60 years later there were over 400. In 1940 there was no ‘psychiatrists’ bible’; in 2014 we have been through five separate versions of the Diagnostic and Statistical Manual of Mental Disorders (DSMs) with a growth from 16 mental disorders to over 300, spread over 947 pages.

In this book we are going to argue that this field of inquiry is ripe yet again for a radical shift, and show what this new shift might look like. In doing so, we are going to commit the same error that all speculators of the future before us have willingly committed. We’re going to ask the reader to suspend their disbelief (a lot) while we posit a version of the UK moving on from 2016 to the year 2050. We’re going to do this to provide a framework for new forms of understanding, institutions and practices that could govern how we might look at mental distress after this much- needed shift.

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