Putting hoof to keyboard to bring you views from the farmyard on public health, public mental health and related issues. And goats. These views are my own, and do not represent those of any organisations or endorse any political perspective – but whatever I'm eating may have been stolen.
Click on the link above for this wise, heartful post by an anonymous blogger who identifies as Dr Goat. This expresses much of how we make sense of human distress at this service. There is (for example) no evidence to support the still widely-touted theory that depression is a disorder of the brain caused by a chemical imbalance – despite extensive and very well-funded research over decades looking for proof. And other psychiatric ‘disorders’ are similarly subjective constructs, lacking an evidence base. The call for ‘parity’ with physical illness is well-intentioned, but fundamentally misconceived and unhelpful in how it is often expressed – making no meaningful distinction between a broken leg and emotional pain/pain in the psyche:-
‘When we describe mental distress in terms of medical pathology (e.g. saying that someone ‘has depression’ rather than that they are depressed, or implying that they’ve ‘broken their mental health’ like we’d say…
It’s encouraging to see the ‘suicide is selfish’ narrative being challenged – but are we any closer to understanding mental health, or achieving parity of esteem?
Millions of us were shocked and hurt by the sudden death of Chester Bennington, who died by suicide two days ago. He was 41. If you don’t know who he is and have never heard anything by Linkin Park, l suggest you familiarise yourself with Hybrid Theory immediately.
As well as sadness and disbelief, public reactions to suicide invariably include the judgemental. It’s the coward’s way out. It’s selfish to those left behind. They should have just pulled themselves together. I’ve seen plenty of those over the last day or so, but they have been far fewer than those expressing sorrow and sympathy, and many people have directly challenged the more hateful comments.
Encouraging as it is, what bothers me is how those defences are being constructed. They all seem to vary on a theme: that depression is a disease caused by a chemical imbalance in the brain, which people have no control over and are stuck with forever, and can happen to anyone without warning or reason. Hardly anyone talks about mental distress, or what might have happened to drive such a talented and much loved musician to take his own life.
Look up Chester Bennington’s history and it’s all there – childhood trauma, loneliness, sexual abuse, bullying, addiction, relationship breakdown. The music that so many related to was his own respite, an outlet for a lifetime of accumulated and unresolved distress.
Part of the problem is in the very notion of parity of esteem itself, or rather how this has been interpreted. There’s increasing consensus that mental health problems should be given equal priority to physical health problems – which, setting aside the problematic concept of mental and physical health as separate entities, is what parity of esteem is supposed to mean. What it doesn’t mean is that we should make direct comparisons with physical health conditions to explain problems like anxiety and depression, or other emotional states indicating mental distress.
On some levels this is appropriate. Most people wouldn’t feel ashamed or embarrassed about spraining their ankle or getting a chest infection, and none of us should be made to feel that way about a mental health problem. We should also receive a proportionate level of support, including adequate time to recover. But the idea that mental health issues should therefore be viewed and treated in exactly the same way as physical illnesses is inaccurate and damaging.
Depression, anxiety, post-traumatic stress and other manifestations of mental distress are usually rooted in experience, and are natural human reactions to adverse events or circumstances. The national Adverse Childhood Experiences study, aside from having the most inappropriate acronym ever, is just one example of how trauma can impact on health and wellbeing much further down the line.
Where these problems do correspond to physiological changes, e.g. changes in brain chemistry, the latter is often a reaction rather than a cause. It’s part of the ‘fight, flight or freeze’ response which is intrinsic to all species.
When we describe mental distress in terms of medical pathology (e.g. saying that someone ‘has depression’ rather than that they are depressed, or implying that they’ve ‘broken their mental health’ like we’d say they’ve broken their leg), we are ignoring the social causes and influences, and trying to ‘fix’ individuals with medical solutions to much broader problems. We view the distress as the problem in itself rather than a symptom, which in most cases oversimplifies the tip of a very complex iceberg. We are also suggesting that the distress is only valid if it has a diagnosis or label attached to it, and can be ‘treated’ with medication.
The result is that diagnostic criteria are continuously being expanded to label more people as ‘ill’, when they may simply not be well or not coping.
The cut-off point for diagnosis is typically described as that which prevents an individual from functioning; but that is largely dependent on our expectation of what functioning means. Someone who still feels unable to go to work a month after a close bereavement isn’t necessarily ill or ‘not functioning’, but expanded diagnostic criteria might label them as such. In our emphasis on economic productivity as a measure of all human worth, we don’t allow perfectly normal emotions like grief to take their natural course. Perhaps it’s the definition of functioning we need to expand to include adjustment, rest and recovery.
That’s not to say medication doesn’t have a place. Many find it helpful as part of the journey to addressing the causes of their distress, or managing the way it manifests itself – but it should never be a sticking plaster, or a (poor) substitute for considering the whole person and their context. Ditto cognitive behavioural therapy, which can be a useful tool in helping people to manage how they respond to their distress, but can also impede long-term recovery through focusing on changing behaviour without fully addressing the causes. All it does is provide a temporary fix until the underlying issues cause the problems to surface again.
That’s the key thing here: underlying issues. There’s a popular view that mental health problems never go away and should be accepted as who people are, but again that implies individual pathology rather than social causes. Not everyone recovers, and some have more recurring episodes of difficulty than others, but that’s often because what makes people vulnerable persists (unaddressed past trauma, or continuing adversity) rather than some underlying pathology. As well as hindering recovery, this mindset diminishes our collective responsibility to prevent and adequately deal with abuse, violence and neglect.
Over-medicalisation of mental distress is partly the reason why anything aimed at promoting mental health invariably ends up focusing on the negative: distress, disorder, illness, or whatever you want to call it. The widely cited ‘1 in 4’ statistic overshadows the fact that 4 in 4 of us have mental health, and we will all suffer some kind of mental distress at some point. It neglects the importance of promoting mental health and wellbeing in individuals, families, communities and populations.
It’s also partly a response to the stigma that still surrounds mental health issues. Many people seek a diagnosis because being able to say there’s something ‘wrong’ with them protects against accusations that their problems aren’t real, or that they can simply choose to stop being distressed. It also allows them to access support that would otherwise be unavailable in the face of increasing cuts to health and social care budgets.
Unless we stop equating medical with valid, and suggesting that only diagnosable ‘mental illnesses’ are worthy of help, then we cannot truly challenge the stigma of poor mental health, or support people to overcome the causes.
Not all parents are women, and not all women are mothers. On International Women’s Day we should be celebrating the whole of womanhood, not just motherhood.
You may have seen MP Sarah Olney’s impassioned speech about how we should be celebrating birth and motherhood as feminine achievements, in honour of International Women’s Day.
Women, she argues, are undervalued in terms of what they do in the home, with all the focus on their professional attainment. She states that women downplay their hard work with regards to childcare, claiming that getting her child to brush their teeth was as difficult as challenging the PM on spending priorities in education – with the former not being acknowledged.
In some respects, I think she makes a good point. Women still tend to do the lion’s share of housework and childcare even when they work the same hours as men, and carer roles in general (which are stereotypically seen as feminine roles) are greatly undervalued in our society. My own mother, who left education early to care for her family when their mother died, was one of the strongest and most amazing women I have ever had the privilege to know, even though it wasn’t for nearly long enough.
However, rather than highlighting this inequality as a persistent social injustice, Sarah Olney’s speech only serves to entrench the beliefs that gave rise to it in the first place: that the role of a woman is as a mother first and foremost, and that parenting is a women’s issue.
Aside from the bizarre notion that we should be bringing the mundanities of everyday life to work (where’s the line here? Should I be congratulated on cleaning my cats’ litter box during a meeting with the DPH?), perpetuating the idea that these struggles are the sole preserve of women is extremely damaging. Instead of asking why we don’t do more to recognise women’s work in the home, we should be asking why that workload isn’t more evenly distributed in a society where female education and employment is now the norm.
There’s the birth aspect of course, which you humans aren’t great at as a species due to insisting on walking upright. Pregnancy and maternity are, of course, women’s issues and perfectly appropriate topics for IWD. I absolutely agree that there needs to be better support for women who have suffered traumatic births, and as much as I advocate for shared parental leave to be split as families themselves see fit, we also need to ensure that a mother’s right to adequate recovery time is not compromised.
Not all women are mothers though, and not all parents (not even all mothers, in fact) go through pregnancy and birth. By conflating the female-specific function of childbirth and the parenting role, and motherhood with womanhood, Sarah Olney is not only suggesting that raising children is ‘women’s work’; she is implying that this is what makes us women, which is very different to recognising it as a women’s issue. To those of us who have opted out of having kids (literally in my case, and not just colloquially), it is deeply insulting – especially when she claims that this is the ‘ultimate’ feminine achievement.
I also don’t doubt that raising children is incredibly hard, and I have the utmost respect for anyone who manages to do it well. But what is hard is largely subjective, and depends on not just the task in hand but on the individual’s capacity, resources and previous experiences.
It’s quite normal for people to find their own life becomes tougher after having children, but that doesn’t necessarily mean their life is intrinsically harder than that of someone without them. The childless or childfree person may have other equally challenging commitments, or may have just started from a very different place. One person might find running 10K as difficult as another finds running a marathon, but it doesn’t mean the distances are the same – it just means there are other factors at play that influence perception. Some will be within the individual’s control and some will not.
To be fair to Sarah Olney, she does try to point out that she isn’t trying to dismiss the many other types of achievements women can have. Claiming something doesn’t make it so though, and it’s a bit like when people say “I’m not being racist but” before going on to make a racist statement. By mummyjacking International Women’s Day, that’s exactly what she’s doing. I’m not suggesting we shouldn’t celebrate mothers, and there are many in my life that are awesome, but in case you hadn’t noticed, there’s another day coming up soon that’s exclusively devoted to their achievements.
Aside from the fact that she wasn’t actually topless and was showing far less flesh than her Harry Potter co-star Daniel Radcliffe did on stage, or Matthew Lewis did on that magazine cover (I’m not posting pictures, but suffice to say that neither of those elicited the same reaction), the responses revealed a lot about how women are viewed. Many people berated Emma Watson for contributing to the sexualisation of the female body, with several claiming that “breasts are for feeding babies”.*
This is a recurrent theme on social media, especially if you happen to be a woman in your 30s whose friends have been busy going forth and multiplying. Breastfeeding selfies and near-naked maternity shoots are shared and celebrated as *empowering*, with outrage if they are taken down under dubious policies on nudity – but pictures that show an equal or even lesser amount of flesh in a non-maternal context (lingerie, swimwear or in Emma Watson’s case some supposedly fashionable crochet) are denounced as contributing to female oppression.
In other words, a woman is only allowed to be proud of her body if she is using it to produce and/or nourish a child. Women’s bodies are only valid if they are serving a reproductive purpose. Not so empowering when you put it like that, is it?
This may all seem like semantics and gender politics, but when you start to think of the real-life implications of this mindset – restricting the reproductive rights of women, being biased against employing women of childbearing age, judging and discriminating against both mothers and childfree alike depending on what side of the fence you sit on – it all gets very disturbing. Especially when you consider that much of it comes not from men, but from other women.
If we truly respect ourselves as women, we have to respect our autonomy as individuals in our own right, not just in relation to someone else.
This means viewing motherhood as one facet of womankind rather than the pinnacle of our existence. It means recognising the substantial societal contributions made by women who are not, and never will be mothers. It means allowing women who are mothers the freedom to have other identities. It means giving men their fair share of responsibility in the home, not just taking equal responsibility outside it.
Equally, it means respecting the choices of those who follow a more traditional route. There’s no such thing as ‘just’ a mother, and there are plenty of badass women choosing to stay at home with their children because that’s what works best for their family. I was raised by one. They are not lesser women, nor lesser feminists for doing so.
Not all parents are women, and not all women are mothers – but we all matter, and we can all make a difference. Happy IWD2017, everyone.
*I could get into a whole evolutionary debate here about the additional function of breasts as a sexual characteristic, but it’s 2017. They’re for whatever the hell we want them to be for.
One person’s sharing-is-caring is another’s piss-off-and-mind-your-own-business.
Everyone’s talking about mental health these days, including me. Last Thursday was Time to Talk Day, which encouraged people to have conversations about mental health to raise awareness and reduce stigma around mental health problems.
What makes me uncomfortable is the expectation of disclosure that is starting to surface, particularly on social media.
Individual stories are powerful tools in challenging public perceptions and stereotypes, and can help those experiencing similar to feel less alone. This blog is not intended to undermine anyone who chooses to share theirs for whatever reason; in fact, I’m incredibly grateful to those who have shared their stories to influence policy and shape the direction of services. But that’s exactly what it should be: a choice.
Lately there is an emerging implication that we somehow have a duty to share our own experiences of mental health problems, because silence implies shame, and that perpetuates the stigma. A recent article in the New York Times posed the question of whether academics should disclose mental health issues to their students, with several comments on social media suggesting that doing so was important for building trust and supporting students who may have similar problems themselves.
Some people just like to keep their health issues private, whether mental or physical, or may simply want to come to terms with their problems themselves before discussing them more openly. If we truly advocate for parity of esteem then we have to respect that right. We don’t go around insisting people talk about the time they had chlamydia, even though STIs also have a history of being stigmatised.
One person’s sharing-is-caring is another’s piss-off-and-mind-your-own-business. It is possible to raise awareness and offer support without sharing personal information with all and sundry, and it is also a collective responsibility that belongs to us all. It is not fair or reasonable to place that burden on the shoulders of unwilling individuals, especially those who may actually be struggling with their own problems at the time.
That’s not to say I don’t want to hear about this stuff at all. Some find it cathartic to share past or present experiences more widely, and if you’re one of them, more power to you. I wish you nothing but the best. I also know myself how much it can help to hear about how someone else has managed a similar situation.
But again, that is something you should choose to give freely, and not be guilt-tripped into doing on the basis of raising *awareness* or breaking down taboos.
The idea that we should be open about our own mental health issues with anyone and everyone is very different to encouraging people to seek help and support when they need it, or helping them to approach the subject with someone they are concerned about.Time to Change‘s activity page is full of different and imaginative ways in which people have started their conversations in a variety of settings, from origami classes to pledges with pizza. (There are plenty of really inspiring personal stories too, and even more cups of tea).
And while we’re on the subject, can we please stop saying that people are ‘suffering from mental health’? We all have mental health, and the aim is to make sure it’s as good as it can be for as much of the time as possible – just like health in general. Too often the conversation is all about mental illness, when we should also be talking about how to improve our mental health and wellbeing.
If you want to share something about your mental health with me, please do so. Tell me about something nice you’ve done for yourself lately. Tell me about what makes you happy. Tell me what you do to relax. Tell me what ‘wellbeing’ means to you.
Tell me what you do to look after your mental health.
Mental health problems affect many people who have served in the Armed Forces. We need to support the living as well as honour the dead.
You may have seen the purple poppies some of us wear leading up to Armistice Day and Remembrance Sunday.
Mine is pinned next to my red one, representing the loss of countless animal lives alongside human ones. Just as the red poppy commemorates those killed in action, the purple poppy acknowledges all the ‘working’ animals used in warfare: as messengers, rescuers, detectors, beasts of burden and even on the front line.
While they make a very valid point, I still wear my purple poppy for the same reason that I wear my red one: because the people we remember are victims too. Many did not give their lives willingly, and those that did saw it as a duty and necessity. Men conscripted to the British Army during the First World War were often no more than boys, expected to be heroes by a society that placed the burden on them to be protectors.
That mentality persists even now. Military service is no longer compulsory in many countries, including the UK, but it remains an obligation in numerous parts of the world – mostly for men, and not always with a civilian or non-combatant option. In the USA there is currently no compulsory military service, but the Selective Service System requires men aged 18 to 25 to register so that they can be drafted in the event of an emergency.
This is in no way intended to undermine the sacrifice made by the men and women who have died, or the choices of those who serve voluntarily. It is thanks to them that many of us are able to enjoy the privileges that we do, and we should never take that for granted.
However, the ‘heroes’ discourse can overlook the true horror of war, and its very real impact on individuals and families.
Voluntary or not, it is not uncommon for veterans to experience mental health problems – including PTSD, anxiety and depression – as they readjust to civilian society. These problems affect not only their physical health (which can in itself be a cause of poor mental health as well as a consequence) but all other aspects of life, and can persist long after the events that caused them. The veterans’ mental health charity Combat Stress lists some of the symptoms of trauma, such as panic attacks, insomnia, feelings of aggression and mistrust, and high-risk or self-destructive behaviour, which can lead to relationship breakdown, unemployment, homelessness, social isolation and even suicide.
Reasons why veterans do not always access the care and support they need are as numerous and complex as their reasons for joining up. The availability of services is an important factor, but the public fixation on strength, bravery and patriotism at the exclusion of stress, trauma and fear has created a culture where many find it difficult to even acknowledge those feelings, let alone address them.
Prevention and early intervention, as with any area of public health, is vital. The British Army is now working to increase awareness of mental health and wellbeing, reduce stigma around mental illness, and improve access to support among serving military personnel, with measures in place for minimising risk and recognising onset of mental health problems.
So, while we remember those who have died, we also shouldn’t forget those who have survived and those who are still serving. They are not just protectors of our populations; they are part of them.
The late Sir Terry Pratchett (mayherestinpeace) once implied that had Jesus been a goatherd instead if a shepherd, the New Testament would have looked very different.
Goats are neither followers nor leaders – not reliably so, anyway. Being intelligent creatures they won’t follow you unless they want to, but don’t ask them to lead you either. They’ll most likely tell you to lead yourself, because they’re busy (probably nibbling something they shouldn’t).
A friend and colleague once told me that everything he had learned about managing people, he had learned from goats. Unlike cows and sheep, which need to be driven, goats need to be led on their own terms. You can try driving them, but that just scares them and they become unresponsive or defensive – and you really don’t want to piss off any beast that has horns.
To lead a goat, you have to interest it. Goats are inquisitive by nature, and will follow you as long as you have something they a) want and b) can’t get more efficiently by themselves (usually a snack, or scratch behind the ears). They won’t follow blindly or unquestioningly, though. Expect to be challenged by your goat, and to have to bring it back when it wanders too far in search of new adventures or (literally) greener grass.
Similarly, if you want a goat to lead you then you need to be interesting and rewarding enough to provide an incentive. They are quick and ruthless in deciding what is worth sticking with and what isn’t.
It can be infuriating when they nibble something and then discard it, but that’s not to say goats are uncommitted or whimsical. Their reputation for stubbornness comes from their remarkable ability to invest time and effort into something they feel is worthwhile. Goats are also strategic thinkers and risk takers. The excellent climbers you see on seemingly vertical rock faces, or up in trees, evolved through setting their sights on more and tastier food (clearly a very strong theme in the goat community).