Click on the above link to visit this U.N. site, for this address by Dainius Pūras on World Health Day. He is a psychiatrist, and representative of the United Nations Human Rights Office of the High Commissioner. If you are a regular visit to this blog, you will know that psychiatrists do not feature frequently. We do not work within or support the biomedical/psychiatric model of ‘mental health’. As Dainius puts it:-
‘The longstanding biomedical tradition of medicalizing various forms of psychosocial distress and human suffering has cast a long shadow over the importance of addressing the social and underlying determinants of health. This not only undermines the right to health, it also ignores a rapidly growing evidence base.
For example, there exists compelling evidence that higher prevalence of depression is strongly linked to early childhood adversities, including toxic stress and sexual, physical and emotional child abuse, as well as to inequalities and violence, including gender based inequalities and gender based violence, and many other adverse conditions which people, especially those in vulnerable situations such as poverty or social exclusion, face when their basic needs are not met and their rights are not protected.’
The writer does not herself initiate or implicitly/explicitly endorse the use of ‘mental health’ language, like ‘depression’ and ‘severe depression’ in making sense of our human experience – although she supports those she works with in making sense of their experience in whatever ways feel useful to them. So some of the language and residual assumptions in this piece sit a little uncomfortably…. However, Dainius is a psychiatrist with a difference, on the evidence here. In fact, he nails it:-
‘…recent decades have been marked with excessive medicalization of mental health and the overuse of biomedical interventions, including in the treatment of depression and suicide prevention. The biased and selective use of research outcomes has negatively influenced mental health policies and services. Important stakeholders, including the general public, rights holders using mental health services, policymakers, medical students, and medical doctors have been misinformed. The use of psychotropic medications as the first line treatment for depression and other conditions is, quite simply, unsupported by the evidence. The excessive use of medications and other biomedical interventions, based on a reductive neurobiological paradigm causes more harm than good, undermines the right to health, and must be abandoned.
….we should not accept that medications and other biomedical interventions be commonly used to address issues which are closely related to social problems, unequal power relationships, violence and other adversities that determine our social and emotional environment. There is a need of a shift in investments in mental health, from focusing on “chemical imbalances” to focusing on “power imbalances” and inequalities.’
At this point, it feels worth saying that in the writer’s decade plus experience as a therapist – working with people with all kinds of psychiatric ‘diagnoses’, from ‘borderline personality disorder’ to ‘psychosis’ to ‘schizophrenia’…the list goes on – she has not once worked with anyone whose experiences, however distressing and outwith social norms, have not turned out to have meaning, and roots in past adverse experience. Not once in 12 years. Many of those people have been forcibly hospitalised and injected with psychotropic drugs against their will – inevitably traumatising them further. This is a vast human rights issue, and normalising/overlooking it is one of those social norms.
There is a huge amount of evidence – traditionally largely ignored by the psychiatric model – showing the beneficial effect for most of us (whatever our psychiatric labels) of supportive relationship, characterised by loving presence, authenticity, empathy and acceptance. Which is what we as a service seek to offer those who walk through our door. Dainius in fact ends his address on this note:-
‘”Let us talk” – is a very good slogan chosen for this World Health Day of 2017. People need to talk about their depression, about what they think might be behind feeling sad or happy. Those who make policy decisions need to talk about what went wrong with addressing mental health of individuals and societies, and how things need to be different now. It may be a hard talk – but even more so it is important that we need to talk.’
Palace Gate Counselling Service, Exeter
Counselling in Exeter since 1994