Charles Hyde

“The good thing about homeopathy is that it doesn’t work, so you don’t get any nasty side effects!” – Unknown.

It is a tough time to be the most widely prescribed anti-depressant. In 2022, Selective Serotonin Reuptake Inhibitors (SSRIs) were found to not function as we thought, hampering serotonin’s reputation as The Happy Chemical (Davey 2022). Maybe this sounds like cause to panic, as everywhere we turn the words “mental health crisis” blare out, but this is why the chemical imbalance narrative of mental illness needs to lose its reputation too. At best, SSRIs work 25% better than a placebo, but the placebo alone can change your mood. Forgetting drugs for a second: fixing your sleep-wake cycle is three times more effective than the best anti-depressants in improving mood (Walker 2017). Yet we are sleeping less and ailing more (Mental Health Foundation 2023). 25% of the UK population is experiencing some mental health issue and medication is still the most common treatment (Mind 2017). Clearly, we have something backwards. Once we stop seeing mental health as purely chemical, important structural factors come into play, something preventative health measures must recognise going forwards.

Embodied trauma and chronic unemployment.

Did you know that if paracetamol were created today, it would not be approved for sale? It doesn’t do enough beyond the placebo effect to be a worthy drug, yet it is the drug we use the most (Nutt 2012). There is no room for such a mind-body connection in a purely chemical view of health, which is odd considering it isn’t news to modern science. In the early 1900s, a group of doctors convinced their patients that a metal radiator rod was a new miracle treatment, and after waving it around the affected areas of the patient’s body, found that they reported less pain (Van Der Kolk 2017). Temporary? Perhaps, but so is paracetamol. Similar to the rod, the act of taking a pill has real power, like ritual.

Those patients treated with radiator rods usually reported vague pains, like musculoskeletal issues (MSK), a diagnosis that is often given without knowing what is the cause (Van der Kolk 2017). More recently, MSK issues affect 30% of the UK population (NHS 2023), rising to 50% when looking at the chronically ill and unemployed (ONS 2022). Scrap metal might not be the answer, but the mind may still be playing a part. Van der Kolk writes that MSK symptoms can be the manifestation of mental health problems. He writes that issues like PTSD, anxiety and depression can tighten the muscles, inflame the brain, raise blood pressure, suppress the immune system, damage digestion and more.

For perspective, these are all symptoms reported by the chronically ill and unemployed. This group was 2.1 million strong in 2019 but this has risen to 2.6 million by 2023 (ONS 2023). Mental health issues and MSK issues are most reported, with 1.38 million people (53%) suffering depression, anxiety or other nerve issues, and 1.35 million suffering MSK issues. Most of the new additions since 2019 report at least one mental health problem, while 38% report five or more conditions including MSK and mental health. Considering Van der Kolk’s findings that personal psychological experience can trigger symptoms

reported to the ONS (also including brain fog, digestion issues, hypertension, worsened allergies etc), a link feels likely when we consider the experiences we have shared since 2019.

Pandemic Pandemonium.

500,000 more people have registered as chronically ill and unemployed since 2019 (ONS 2023). Some doctors are worried that this rise is because we are medicalising day-to-day stresses and anxieties (The Economist 2023). However, the last four years included a global pandemic and national lockdown, corrupt and incompetent politics (Calvert and Arbuthnott 2022), the threat and effects of climate change, the instability of Brexit and the related concoction of a faux culture war (Duffy 2021), and more recently the cost-of-living crises and two major conflicts in the Global North. We learn about current affairs looking down at the small screens of our phones, and on social media, with both the size of our screen and the social media algorithms causing anxiety and brain fog (Huberman Labs 2021). In those four years, the ONS (2022) has found that depression has jumped from affected 1 in 10 people to 1 in 6 people. Clearly the structures around us are sick, so how do we treat them?

At least some of these stressors could be eased if the government took inequality a bit more seriously. According to the NHS (2023), ‘Black or Black British’ people were over four times as likely to be detained under the Mental Health Act than ‘White British’. The ONS (2022) found that unpaid carers are nearly twice as likely to report depression than non-carers (37% against 17%), and those having trouble with rent, mortgage, credit or energy bills can be two or three times as likely to develop depression than those without. Yet the government rhetoric has been that the benefits system is rife with fraud (fraud sits at below 5%) (Department of Work and Pensions 2023). Their issue seems to be specifically that these people are unemployed and need to get back to work as soon as possible. Except these people are not even really ill in the way we currently think – they don’t necessarily have mental issues, but very real material issues.

What we learn about ourselves.

Perhaps an education system better tailored to living our lives would help. How much money and time could be saved if functional knowledge was more common – DIY repair work, navigating the job market and financial world, taxes, digital literacy. Maybe the traditional curriculum could teach us how to take care of our body and mind: how our behaviours affect our mental states, how our mental states affect our biology, how the chemistry of cooking can alter our mood and wellness etc. Just like the ONS reports separate mental health problems from physical health problems, our school subjects are clearly divided. Perhaps it’s efficient, but it means PSHE grows yearly to try to fill in the gaps left by a system which separates education from life. The LSE (2023) found that mental health costs the UK £117 billion annually in intervention and lost productivity – how much of this would be better spent in pre-emptive upskilling? Instead of just trying to reduce unequal access to education as it is, we need to update it – an overlapping education for our overlapping problems – building competence and confidence. After all, we may need more generalists than specialists to fix the future (Epstein 2019), and we better start soon.

Bibliography

Calvert, J. and Arbuthnott, G. (2021). Failures of State: the inside story of Britain’s battle with Coronavirus. London: Harper Collins Publishers.

Davey, C. (2022). The Chemical Imbalance Theory of Depression Is Dead – but That Doesn’t Mean Antidepressants Don’t Work | Christopher Davey. [online] The Guardian. Available at: https://www.theguardian.com/commentisfree/2022/aug/03/the-chemical-imbalance-theory-of-depression-is-dead-but-that-doesnt-mean-antidepressants-dont-work.

Department of Work and Pensions (2023). Fraud and Error in the Benefit system: Financial Year 2022 to 2023 Estimates. [online] GOV.UK. Available at: https://www.gov.uk/government/statistics/fraud-and-error-in-the-benefit-system-financial-year-2022-to-2023-estimates.

Duffy, B. (2021). The Generation Myth. Basic Books.

Epstein, D. (2019). Range : Why Generalists Triumph in a Specialized World. New York: Riverhead Books.

Huberman Labs (2021). ADHD & How Anyone Can Improve Their Focus – Huberman Lab. [online] http://www.hubermanlab.com. Available at: https://www.hubermanlab.com/episode/adhd-and-how-anyone-can-improve-their-focus [Accessed 27 Dec. 2023].

Mental Health Foundation (2023). UK adults report poorer sleep, seeing friends less often and exercising less as financial strain takes its toll – new survey results. [online] http://www.mentalhealth.org.uk. Available at: https://www.mentalhealth.org.uk/about-us/news/new-survey-results-report-concerns-due-financial-strain.

NHS (2022). Mental Health Act Statistics, Annual Figures, 2021-22. [online] NHS Digital. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-act-statistics-annual-figures/2021-22-annual-figures#highlights.

NHS (2023). NHS England» Musculoskeletal health. [online] http://www.england.nhs.uk. Available at: https://www.england.nhs.uk/elective-care-transformation/best-practice-solutions/musculoskeletal/#:~:text=They%20can%20range%20from%20minor.

Nutt, D. (2012). Drugs — without the Hot Air : Minimising the Harms of Legal and Illegal Drugs. Cambridge: UIT.

Office for National Statistics (2022). Cost of Living and Depression in adults, Great Britain – Office for National Statistics. [online] http://www.ons.gov.uk. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/mentalhealth/articles/costoflivinganddepressioninadultsgreatbritain/29septemberto23october2022.

McDaid, D. (2022). Mental Health Problems Cost UK Economy at Least £118 Billion a Year – New Research. [online] London School of Economics and Political Science. Available at: https://www.lse.ac.uk/News/Latest-news-from-LSE/2022/c-Mar-22/Mental-health-problems-cost-UK-economy-at-least-118-billion-a-year-new-research#:~:text=Mental%20health%20problems%20cost%20the.

The Economist (2023). How to stop over-medicalising mental health. [online] The Economist. Available at: https://www.economist.com/leaders/2023/12/07/how-to-stop-over-medicalising-mental-health