So today I heard on the radio that 3 point something percent of medical students are suffering from a severe form or mental illness, which was described as anxiety or depression. A brave young doctor spoke out about her own experience. You can find the information here .
What I want to say about this is simple, and I believe vital.
That we regard “anxiety/depression” as “mental illness” is part of the problem.
“Illness” is seen as a pathology – a deficiency in coping or at least in your chemicals. What if this very “definitional ceremony” of diagnosing “mental illness” is a large part of the creation of said “illness”?
What if anxiety and depression were instead regarded as normal consequences in normal people when pushed to perform above their capacity, repeatedly, with constant threat of punishment for any failures? What if this is the major problem in medicine?
Without raving on, which is my usual penchant, I’ll just say what I think.
I believe that much (not all) of what we call mental illness is socially constructed and the process of diagnosing distracts us from this particular causal factor. Instead of looking upstream, we devote our efforts into trying to help individuals who are sidelined because they are unable to deliver as we increase the expectations upon them.
Then we add insult to injury, calling their experience an illness, rather than normalising it. This amplifies fear, stress reactions, immune suppression, inflammation and they then get ill. We are getting close with the associations now, (see here) but perhaps the experience of being labelled is more cause than effect?
This I sincerely believe. I’m not alone. The whole discipline of narrative therapy (which is a wonderful adjunct/alternative to modern psychiatry by the way) acknowledges this possibility and this enables different solutions. To me the obvious remedy is upstream prevention:
- Stop demanding super-human performance from humans.
- Stop calling medicine a tough profession.
- Stop making medicine a tough profession.
- Stop expelling gentle, methodical and slow people from the profession using terms like “inefficient”, “indecisive”, “weak”, “not a leader” and so on.
- If you are a patient, demand reform from the profession and if you can, offer help to activists seeking healthcare reform. Stressed doctors aren’t serving you well. Perhaps join Getup or contact The Health Issues Centre and find out what you can do to help.
Let’s upskill people in health literacy so they don’t need to rely on doctors and the health system so much. Let’s stop regarding anxiety and depression as mental illness and lets call it what it is.. normal consequences of an abusive culture in motion. Abuse is being forced to do something you can’t or don’t want to do. These doctors can’t and don’t want to be at 5 bedsides at once (not to mention the nurses who have similar demands placed on them). They don’t want to work 3 hours overtime without pay, and we shouldn’t expect them to. The fact that they earn more than average is a distraction in the debate about preventing mental illness in the professions we need the most.
Western Australian GP Dr Sarah Newman is brave to bring up the issue. I hope the planned Perth conference about the issue discusses the social construction of mental illness. To not do so would be a missed opportunity.