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My own view is neither that mental illness was scandalously under-diagnosed 50 years ago nor that what prevents it being treated properly even today is that we still aren’t talking about it enough. There may well be a crisis here. But I think this lies in a medicalised, pseudo-scientific frame of reference and language being applied where they don’t belong.

Let me explain. When someone comes to see me complaining about their anxiety or depression, my heart sinks. Not because I’m an unempathic therapist who thinks only about his fee, but because I anticipate having to work long and hard before there is likely to be a prospect of getting past these vague, neutral-sounding labels to the powerful and visceral feelings this person is probably overwhelmed by but largely unaware of. Often involved are things like rage, loss, fear, love, envy, hurt, hope, disappointment, jealousy and greed. These have been the stuff of art, poetry and fiction for hundreds of years, if not longer, and that is to be expected because they are what we are made from too.

So why is it that these tend to be absent from the debate around mental health? Why does so much of that come over either as safely bureaucratic (“services”, “interventions”) or strangely anodyne (“wellbeing”)? Does the language used have to be so mind-numbing — and if so why? I think there is a range of possible answers to this question and will limit myself to considering four of them.

The first of these follows from the fact that the way the mind is understood nowadays is essentially materialist (in the philosophical sense of the term). We may not be machines, exactly, but the consensus view among scientists on the one hand and practitioners of so-called Evidence-Based Medicine on the other, is that the mind doesn’t exist independently of the brain — countless neuroimaging studies are said to confirm this — and therefore in speaking about mental health we are really speaking about the health of the body or its organs. If this is your starting-point, then mental health problems are no different to the illnesses that doctors treat patients for all the time.

It’s true that there are many health professionals (and indeed scientists) who don’t take this view. But there is no arguing with the success modern medicine has had in tackling and sometimes eliminating diseases that filled earlier generations with fear. So of course there are hopes that the same methods can be brought to bear on the equally frightening afflictions of the mind. Though politically on the centre-right, The Times has recently become a champion of such hopes, loudly calling for more investment in mental health services. And in one of several editorials it ran last year pressing for this, mental and physical illness were naively equated with each other in a way that I suspect owes a good deal to wishful thinking: “Mental illnesses such as depression or obsessive-compulsive disorder are as real as cancer and kidney failure but they are as yet only dimly understood.” As we have seen, the reality of most mental health conditions is anything but clear-cut — it depends what you think these are to begin with — and assuming they are in the body or brain does not get round what is fundamentally a philosophical problem so much as relocate it.
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