Dorothy Rowe

October 2006

Don't Be Afraid to Embrace Change

With all the self help advice we get now, how is it that we still get stuck in bad relationships, or dreary jobs, live where we don't want to live, do things we know are bad for us, or just feel generally miserable? I meet a great many people who tell me that they've had counselling and they understand much more about themselves but they're still depressed. Why do we get stuck and why can't we change?  

There are two reasons we stay stuck. The first is that we're not prepared to give up a reward, and the second is that we're afraid of change. 

Not Wanting to Give Up a Reward. 

Whenever we do something that causes us nothing but pain we try never to do that thing again. For instance, when we were a small child we put our hand on something that was extremely hot. We felt total pain, and ever since then we've tried to avoid anything that might burn us. At the same time, we might have hated to take the medicine our mother gave us because it was bitter and horrible, but we found that, if we took our medicine nicely, mummy gave us a special hug and kiss, and that made us happy. We learned to put up with something nasty in the hope of some reward. In adult life, if we go on doing something that hurts us, it's because somewhere in it is a reward. A very common example of this is smoking. Everyone knows that smoking causes lung cancer, emphysema, heart disease and, worst of all, it wrinkles and ages your skin, but it does give a reward, a lessening of anxiety and something to do with your hands when you're feeling nervous. So you go on smoking.  

Sometimes the reward you get is knowing that, even though you're suffering, you've a good person. Many women stay in the most abusive relationships because they want to think of themselves as being kind, loving, and sensitive, that is, good, and to leave the relationship they believe they would have to be unkind, unloving and insensitive, that is, bad. In the same way many people go on being depressed because they prefer to be good than happy.

The reward for staying in a dreary job might be that you don't have any responsibilities and thus you don't get blamed for anything. You might be telling yourself that you can't take on responsibilities because you don't have any self-confidence. The great rewards for lacking self-confidence are that other people do things for you, you never lose a competition because you never enter one, and people are always trying to bolster your self-confidence by telling you how wonderful you are. Become self-confident and all these rewards vanish. 

The reward for living somewhere where you don't want to live could be that you feel safe with your family close by, or you stay in a place which is familiar because you're terrified of strangers and strange places. Again your problem is a lack of self-confidence, and your reluctance to overcome this. 

If you want to become unstuck you have to identify what the reward is in your stuck position. Then you have to ask yourself, 'Am I prepared to give up this reward?' If your answer is, 'No,' then you may as well resign yourself to being stuck and stop complaining about it. Don't whinge to yourself like a small child that it's not fair that you can't have everything. Growing up means knowing that you can't have everything, and that you should go for the important rewards and discard the unimportant ones. 

Fear of Change. 

Growing up also means being courageous and knowing how to tolerate uncertainty. Change always involves uncertainty. We map out what we intend to do, and then we discover, as John Lennon said, 'Life is what happens while we're making other plans.' Life never turns out to be what we predict it will be.  

Many people lead dreary, unhappy lives because they fear to change. They think that if they stay as they are they can predict exactly what is going to happen. As the old proverb says, 'Better the devil you know than the devil you don't know.' Unfortunately, the devil you know can always surprise you. You can't avoid change by refusing to change. 

Everything in this world is somehow linked to everything else. Do something, and the ripples - the consequences - spread out in all directions. There is no way of knowing just what all these ripples or consequences are, and we certainly can't control them all. When some people think about what all the possible consequences of some small action might be they feel helpless. Feeling helpless can be frightening, and so many people decide not to act. But deciding not to act is as much a decision as deciding to act. Every decision has consequences, and you can't avoid the consequences. Being brave isn't being without fear. It is acknowledging your fear but still acting in the way you know is right for you. 

At some point in the future you're going to look over your life and assess it.  Do you want to have to say, 'I wasted my life because I was too afraid to take the best opportunities life offered me,' or do you want to be able to say, 'I lived my life to the full. I couldn't take all the opportunities life offered me but I chose the best of the opportunities I had and made the most of them'?

Dorothy Rowe on the bad science of positive thinking

Barbara Ehrenreich is a renowned American writer who is relentless in her pursuit of those who prefer fantasy to the truth. Her latest book, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America[1], followed her encounter with the fantasies that prevail in the treatment of breast cancer.

Ehrenreich developed breast cancer in 2000. She had been taking hormone replacement therapy for eight years, 'prescribed by doctors who avowed that it would prevent heart disease, dementia, and bone loss. In 2002 HRT was shown to increase the risk of breast cancer, and, as the number of women taking it then dropped, so did the incidence of breast cancer. Ehrenreich had not only discovered the bad science of HRT but she had also encountered the bad science of positive thinking.

Ehrenreich holds a PhD in cell biology and thus looks at research, whether in biology, medicine or psychology, with a scientist's stern eye. Since the 1970s it had been known that severe stress 'could debilitate certain aspects of the immune system'. It's now clear that severe anxiety or deep depression can lead to cancer or heart disease. However, the reverse of this isn't necessarily true. Positive thinking doesn't prevent cancer, nor does it cure it. Being as brave and positive as you can manage to be undoubtedly is helpful in getting through each difficult day but you would be lying to yourself if you told yourself that you were thinking nothing but positive thoughts. Yet, when Ehrenreich posted a statement on one of the popular breast cancer websites about how angry she was with all aspects of what she was going through, every respondent but one chided her severely for her negativity. The only respondent who agreed with her was a woman whose cancer was terminal. All her positive thoughts had failed to cure her.

Ehrenreich had discovered that in the USA 'cheerfulness is required, dissent a kind of treason.' She found this attitude had a long history, beginning with the Calvinist early settlers and evolving over the years to the belief that positive equals good for which you'll be rewarded and negative equals bad for which you'll be punished - the Just World belief in another guise. If we believe in any of the various versions of the Just World, as each religion obliges us to do, and, if we have not developed any ability in sceptical, critical thinking, we can be gulled into accepting all kinds of ridiculous ideas by people who don't have our best interests at heart. Ehrenreich explored some of these ideas as they occur in positive thinking in everyday life, religion, business, and in therapy and life coaching. Here I want to talk about Martin Seligman and the industry of Positive Psychology.

When Aaron Beck first developed cognitive behaviour therapy he wanted to teach people how to be sceptical and critical of their own thinking. If his patient said to him, 'Everybody in the world hates me,' Aaron would point out that, first, his patient hadn't met everyone in the world, and that, while some people might dislike him, some didn't.' While some therapists still strive to teach their clients sceptical, critical thought, others prefer the fantasies of Positive Psychology that say that being optimistic will bring you happiness, good health and success. 'The science of happiness' of which Positive psychologists talk, has all the scientific rigor of Scientology or Christian Science. As President of the American Psychological Association, Seligman made Positive Psychology respectable. He attracted huge grants, and PhD students built up a large volume of research reports linking optimism to all kinds of desirable outcomes. (In psychological research that uses questionnaires it's very easy to get the results you want. Just select your subjects and your questions carefully.) Many of these PhD students became life coaches who wrote mass-market books advocating Positive Psychology, while Seligman developed a cash-generating website with exercises that promise to increase your happiness.

From all of this vast industry something is missing - any mention of the terrible things that happen in our world. No mention of war, poverty, climate change, and the people inescapably involved in these catastrophes. According to the gospel of Positive Psychology, all of these people are failures because they have harboured negative thoughts.

This cruel fantasy has little connection with real life. No amount of positive thinking can prevent disaster, betrayal or loss, but truthful, unselfish thinking can sometimes prevent and always mitigate such catastrophes. By valuing ourselves and other people, we can work together to make all our lives better. Ehrenreich finished her book by pointing out that we mightn't succeed in all the things we want to do, 'but - if I may end with my own personal secret of happiness - we can have a good time trying.'

Published in openmind 162 March/April 2010

Don't get depressed in Alaska

My son Edward spent September in Alaska, exploring the glaciers and reading the local papers. He texted me to say that in the Anchorage Daily he'd read about Sarah Palin's autobiography which she had written (with the help of a professional writer) in just four months. A spokesman from her publishers, HarperCollins, said that Sarah had worked very hard. She was, he said, 'very hands on.' Edward then expressed the hope that I had been very hands on with my new book, Why We Lie that I had just delivered to HarperCollins.

Edward also sent me a bundle of Alaskan newspapers, choosing ones that had articles on mental health. On September 20, the Fairbanks Daily News published a magazine called Parade in which 'Top Doctors Solve Your Medical Problems'. One of these doctors,  Ranit Mishori, told readers how to 'Cope with Depression'. Often, she said, people are depressed without realising that they are. However,

'The good news is that there are many effective treatments. More than 27 million Americans take some form of antidepressant. Most of these work by affecting the brain's levels of serotonin, dopamine, and norepinephrine - chemicals that influence mood. The most popular are SSRIs (selective serotonin reuptake inhibitors), of which Prozac is the best known example. But there are dozens of drugs that work in different ways. Talk therapy or counselling also helps. Studies have shown that, for most people, combining medicine and talk works best. For those whose depression is very hard to treat, there are other alternatives, though most are experimental.'

She went on to list four treatments: vagus nerve stimulation, where 'electric currents stimulate the vagus nerve, which is located in the neck, via a generator implanted in the chest'; transcranial magnetic stimulation where 'magnets are applied to the scalp to create electric fields'; deep-brain stimulation where 'a pace-maker-like device implanted in the chest sends electric currents to electrodes connected to mood centres in the brain'; and electroconvulsive therapy in which 'electric currents are sent to the brain to trigger a small seizure has changed dramatically since it was first introduced decades ago. The major side effect is temporary memory loss.'

Here in the UK some psychiatrists would see  Mishori's article as being quite reasonable, but others, those who keep up with the research and follow the advice on the treatment of depression as given by the National Institute of Clinical Excellence (NICE), would see that article as being quite out of date. NICE divides depression into mild, moderate and severe, and advises that medication should be used only with severely depressed people. However, all levels of depression require psychotherapy. The system that the government is developing to provide different kinds of therapy for different degrees of unhappiness and depression has many teething problems, but at least it recognises that depression is one of the ways we can manifest our severe mental distress. Unfortunately, the most popular therapy, CBT, uses the language of medicine to talk about mental distress. This is as sensible as talking about music but using the language of playing golf.

Many people contributed to this important change in how we understand ourselves, not least those who were depressed. One professional who contributed to this change was David Nutt, the psychiatrist who so angered Alan Johnson with his research into recreational drugs that showed that cannabis is less harmful than alcohol or nicotine. In 1999 David Nutt and his colleague Sam Forshall published a short report on their work of reviewing 'current evidence and opinion with regard to the long-term treatment of unipolar depression'. Here they wrote, 'Of those who have suffered one episode of depression 50-80% will have a subsequent episode, while of those who have two episodes, 80-90% will develop a third. With each recurrence a further recurrence becomes more likely and the period of remission tends to become shorter.'[1] 

This short paper might have upset those psychiatrists who wanted to continue believing that antidepressants cured depression, but eventually most of them had to admit that depressants don't cure depression but simply reduce people's awareness of their emotions. Some depressed people find this helpful but many do not. Painful emotions, like physical pain, tell us that something is amiss and we have to acknowledge this in order to put it right.

How is it that depression is seen so differently here from the way it is seen in America? American psychiatrists and the pharmaceutical industry work closely and profitably together in a system based on the belief that depression is a physical illness. They cannot afford to change their minds. Whereas in Britain the system allows professionals to change their minds. This is the system that many Alaskans assured Edward was a version of Nazism, the wicked NHS.

Dorothy Rowe on the Stuart Low Trust

In August I gave a talk at one of the suppers at the Stuart Low Trust in Islington. This was the second time I had been there, and both occasions I enjoyed my visit enormously. Apart from the fact that everyone there was warm and friendly, my pleasure comes from seeing there how much ideas and practices have changed since I first arrived in Englandin 1968.

I had been working in Sydney as a liaison psychologist between the children's unit at the new psychiatric hospital at North Ryde and the schools. In Australia at that time many of the psychiatrists were interested in psychotherapy, and were concerned about understanding their individual patients rather than finding a diagnosis for each of them. Alas, now biological psychiatry is all the rage there, and ECT is regarded by many psychiatrists as the treatment of choice. Always remember, progress has to be guarded carefully because it can easily disappear. However, expecting that British psychiatrists would be like the psychiatrists I had been working with, I arrived in London and applied for a job as a clinical psychologist at Whiteley Woods Clinic in Sheffield. I got the job, principally because I was the only psychologist who had applied and they needed to fill the post. This clinic was part of the Department of Psychiatry at Sheffield University, and so I was at the cutting edge of British psychiatry. It was all diagnosis, drugs and ECT.

That was shock enough, but worse was to come when I was asked to see a patient who was in Middlewood Psychiatric Hospital. I could not believe my eyes. How could people who regarded themselves as being well educated, humane and caring put fellow human beings who were suffering great mental pain in such a disgusting, demeaning place! I came to know such places well, and the people in them, both the patients and the staff.

I learned to recognise all the stigmata that develop from time spent on a psychiatric ward. These were not the stigmata of madness - there aren't any - but the stigmata derive from the drugs patients were forced to consume, and from the effects of being treated as if you are something less than a human being, something of very little value. These stigmata can be seen in the way people move and in the way they relate to other people. Some people managed to throw the stigmata off soon after they left the psychiatric hospital, but others found that they had been marked for a very long time. As I sat talking to the delightful young man who was to introduce me when it was time for me to talk, I was watching the members of the trust enjoying the supper they had provided and prepared for themselves. It was clear to me which of them had spent years in a psychiatric hospital and which of them had escaped relatively unscathed. However, there was a huge difference between patients that I had once had known and the people I was with.

When you are a patient on a ward it is hard to make friends, either because the cotton wool in your brain put there by your drugs precludes any meaningful interaction, or because no one is on the ward long enough to get to know them. On acute wards patients could come and go very quickly. They might be discharged or moved to another ward. You learn to withdraw into yourself in order to look after yourself. The Stuart Low people had cast all that off. They talked to one another as old friends, and showed one another little acts of kindness, just as they did to me. Some of the people who talked to me revealed that shakiness we all feel when our self-confidence is easily punctured, but they were there taking part, and not hiding away in their room.

How had Virginia Low, who started the trust in memory of her son Stuart, achieved this? Simply by providing a structure where lonely, anxious people who had been through a terrible time could meet, do ordinary but pleasant things, and get to know one another. There are many groups that operate in much the same way as the Stuart Low Trust, groups that see no need of a PR person or a celebrity to proclaim how wonderful they are, or a charity ball to raise funds.

At supper I saw a number of people pile their plates with food and eat hungrily. I was concerned that they were not managing to look after themselves properly. Then it dawned on me that probably they were just like me. They lived on their own as I did and enjoyed it when somebody else cooked them a meal.

Published in openmind 160
November/December 2009

I have been reading Jean Davison's The Dark Threads (Accent Press) about the time she spent as a patient at High Royds Psychiatric Hospital in Yorkshire when she was just eighteen. Jean waited forty years to complete writing this book, which was very wise because she was able to give an account of her experiences that showed a wealth of understanding rarely found in memoirs written when emotion is still very much alive. I found it a painful book to read, because I was a psychologist then at Whiteley Woods Clinic and Middlewood Psychiatric Hospital in Sheffield. I witnessed the kind of scenes in which Jean was a participant, and so her book took me back to those times when I saw the cruelties that passed themselves off as psychiatric care. I tried to deal with the awful helplessness of witnessing cruelty and being unable to prevent it by spending time talking with the patients. In so doing, I came to see the gap between the way psychiatrists and nurses thought and worked and the reality of the patients' lives. In recounting her interactions with the people who were supposed to be looking after her, Jean shows just how great this gap was.

She also shows that these men and women were not monsters determined to do evil. They all meant well. Her consultant,  Sugden, was just like the consultants I worked with. These men were practising the psychiatry they had been taught ten or more years before. It did not occur to them to question what they were doing because that was how the system worked, and they benefited from the system.  Prior,  Sugden's junior doctor, did no other than elaborate Jean's diagnosis by  Sugden. He dared not query the diagnosis because his future career depended on  Sugden's good will. Sister Oldroyd was a martinet. She terrified the patients, but was herself frightened of  Sugden. However, in one encounter, through the fog of drugs that filled her head, Jean could see that she was a tired woman 'bending under the burden of a difficult, depressing job'.

What Jean could not report but I can was what these people said privately to one another about the patients. They all saw the patients as inferior beings whom they tried never to encounter outside the hospital. The consultants patronised the nurses to their faces, but amongst themselves they agreed that the nurses were not intelligent or educated enough to understand what the practice of psychiatry was. The nurses knew what the consultants thought, but got their revenge. If they could make their consultant dependent on them, they did, and they had no difficulty in manipulating the junior doctors' weaknesses.

Much in the current psychiatric system maintains this pattern of relationships, but, so I do not fall into despair, I remember that there are now consultant psychiatrists like Sami Timimi. His latest book Straight-Talking Introduction to Children's Mental Health Problems is amongst of the first of a series of pocket-sized books from PCCS Books, called Straight-Talking Introductions to Mental Health. Sami has never had any difficulty in writing in ordinary language free of the jargon so beloved of psychiatrists and psychologists who want people to think that they have special knowledge that no one else possesses. He treats adults and children as fellow human beings, and never feels the need to patronise them. In his book, he aims to make sense of childhood distress without having to resort to psychiatric diagnoses. Indeed, he wrote, 'There are currently no childhood psychiatric diagnoses whose existence in the objective physical world (beyond the subjective imagination of the diagnosing doctor) is not disputed. The classification system we use for categorising childhood psychiatric disorders did not develop as a result of new discoveries, but as a result of a change in the way we think about and categorise children's emotions and behaviour.'

Not all of Sami's colleagues will be pleased with him giving their game away like this. They will be even less pleased that his book includes step-by-step instructions about how to wean a child off Ritalin. Research by Mind has shown that many doctors do not agree to help when patients say that they want to come off their psychiatric drugs. Perhaps these doctors genuinely believe that their patient needs to keep taking the drug for years to come, but a sceptical person might wonder whether a doctor might want their patient to remain dependent on him. Does he prefer, as Jean's psychiatrists preferred, to believe in lifetime mental illnesses rather than look at what actually happens in life?

Everyone concerned with children should read Sami's book. If only, forty years ago, Jean could have read a little book like Sami's about being a teenager in a troubled family!

Everything in our world is connected, says Dorothy Rowe

One of the hardest jobs you can ever undertake is to persuade people to abandon comforting old ideas and accept challenging new ones. People resist new ideas, even when these new ideas might benefit them. Members of MIND have had some success in persuading some people that madness isn't a mysterious malady that overcomes certain individuals and turns them into objects of no importance but is simply a desperate way of trying to survive when, overwhelmed by events past and present, we lose all confidence in ourselves. However, we haven't persuaded everybody of this. Many psychiatrists and psychologists still use the language of illness, and many people in the throes of severe mental distress are led to see themselves as being degraded and valueless. Though individuals have told me that what I have written has helped them, I feel that I have made little difference to society generally. However, while visiting Taronga Zoo in Sydney, I realised that there are people who must feel the same about their work. Everyone who works at the zoo tries to educate their visitors about the importance of looking after the planet and all the creatures that inhabit it, and every day, as they walk around the zoo, they can see that they have failed to impart this lesson.

Taronga Zoo occupies 43 acres of land that slopes steeply down to Sydney Harbour. When it opened in 1916, its aim was to exhibit exotic wild life. As a child I visited it in the 1930s when the animals and birds were in cages, and some were used to entertain the visitors. A popular pastime was elephant rides, where each elephant carried six or eight people sitting back to back on wooden seats running the length of the elephant. The keeper didn't object when my father, a heavily built man, climbed aboard and nearly destabilised the whole contraption. It was the visitors, not the animals, who mattered.

However, by 1967 ideas had changed, at least amongst scientists who studied wild life. The zoo still needed to attract visitors to pay for the zoo's upkeep, but now the emphasis was on scientific research, conservation and education. In 1977 a second zoo was opened on 300 hectares of land on the western plains of NSW. This zoo was built on the open range principle, where moats replaced fences and visitors could feel that they were sharing the land with the animals.

My son Edward and I had stayed overnight, sleeping in a tent, at the Western Plains Zoo and, more recently, we visited Taronga Zoo where, in contrast to my childhood visits, we saw the inhabitants across moats, or through glass, or from vantage points above them. At every appropriate place there was well-presented information about the wildlife we were looking at and where they came from. We were being educated about our fellow inhabitants of this planet, and we were learning how to think scientifically. At different times during the day the keepers gave talks about the animals in their care. The Seal Show, presented in a large open-air auditorium beside a deep pool, was particularly popular. Here the seals and their keepers presented some clever lessons about not scattering our litter on land and sea.

Yet many people in that audience failed to understand the message. The empty auditorium after the show revealed the litter left behind. Along every path, often no more than 25 metres apart and clearly labelled for recycling, were a multitude of garbage bins, yet all the time some of the zoo staff were busy collecting rubbish dropped by lazy visitors. The lessons about thinking scientifically were lost on those visitors who, on seeing a shallow pool unguarded by glass, were impelled to throw a coin in it. Edwardassured me that Australian coins are made of an alloy that was unlikely to harm the wildlife in the pond, but he, like me, was appalled that so many people still believed that, if they threw a coin into a pool and made a wish, some mysterious being - God, Fate, angels - would grant that wish. Taronga Zoo is a charity and grateful for financial help, but they don't provide Trevi Fountains for the gullible.

Changing our ideas creates uncertainty, and many people fear uncertainty so much that they prefer fantasies that give the illusion of certainty rather than face the reality of their situation. Another of our illusions is that we are superior to the other inhabitants of the planet, be they elephants or people who do not share our beliefs. Our reality is that in the world we live in a world where everything is connected to everything else, and this includes ourselves. If we are to survive as a species we have to learn about and look after everything on our planet.

Published in Openmind 156 March/April 2009

Dorothy Rowe on the comforts of being a victim

BBC Radio 4 programme You and Yoursis aimed at helping people with the practical problems that can arise in their lives. Not surprisingly, at present the programme is examining the financial problems besetting many people. Amongst those being interviewed the other day was a man in danger of being made bankrupt by his council for non-payment of council tax. This is a terrible situation to be in and the presenter was very sympathetic, but she had to ask the question that everybody listening was asking, 'Did you talk to the council about the financial difficulties you were in?' He said that he hadn't because he had other matters to attend to. But surely he knew that, when you can't meet your payments, the first thing you should do is talk to your creditors to see if your payments can be adjusted so that you pay whatever you can manage to pay. Some creditors can be ruthless and hard-hearted, but councils have a policy of trying to help people well before the council resorts to bankruptcy, but they can't do anything if people don't get in touch with them as soon as they have money problems.

The presenter explained this but the man rejected it. As far as he was concerned, it was the council's fault. He said, 'No one knocked on my door and asked if I was in a bit of bother. They're just sitting up there, drinking cups of tea, and doing nothing.'

If you were listening to this and had read Eric Berne's wonderful book Games People Playyou'd have recognised immediately that what was being played out here was the game Berne called 'See what you've made me do.'

Bernehad recognised that in our relationships we often play games. What we do might look as if it's an ordinary interaction between two or more people but actually we're playing a game where we try to score points or justify what we do. We learn these games in childhood when we're trying to survive the hazards of family life, but, if we are unwise, we continue to play them in adult life. Then they become the total pattern of our life, always with disastrous results, perhaps the loss of our home, or a lifetime as a psychiatric patient who played the game, 'See what you've driven me to, Mother!'

As children we're at the mercy of those adults- parents, teachers, older siblings - who should be looking after us but often they fail to do so. To complain would provoke punishment, so why not punish the adults by becoming a very visible victim of something the adult has done. For instance, you're not hungry but your mother insists that you eat what's on your plate. You obey, and then you throw up, messily and publicly. See what you made me do, Ma.

There are an infinite number of scenarios where this game can be played, but the payoff is always the same. You want to punish the person who has failed to treat you with the respect you know you deserve, but you don't want to risk suffering a painful retaliation. By becoming a victim of the negligence committed by the person you want to punish, that person is humiliated by having to apologise for what he had done, or failed to do. As a victim, you aren't responsible for what has happened, and, even more, onlookers will take notice of you and try to help you. This is very comforting if you've been feeling helpless, ignored and friendless.

From an early age children have a keen sense of justice. Most children acquire the belief that we live in a Just World where good people are rewarded and bad people punished. As a child you can feel aggrieved because you've been good and you haven't been rewarded. You want to draw attention to the fact that this wrong must be righted. If this game works when you're a child, you might resist learning that we don't live in a Just World but a world where things happen by chance.

The best measure of maturity is the degree to which we accept the uncertainty of life. The world isn't governed by a Grand Design where rewards and punishments follow what we do as night follows day. Being good doesn't ensure that you will be looked after, or that those who have failed you will be punished. If we ask people for help, some people will refuse us while others will do what they can. No other person is able to meet all our needs and wishes. The only person who will look after us is ourselves. The council isn't going to come to you: you have to go to them.

Published in openmind 155 January/February 2009

Alex, aged two, and Rebecca, aged four, had three things in common. They had each been diagnosed as having bipolar disorder, each had spent most of her life taking the antipsychotic drugs that had been created for adults, and each suddenly dropped dead.[i] David Healy has told their stories in his latest book Mania: A Short History of Bipolar Disorder.[ii] This book is essential reading for anyone who wants to understand what is happening now in the marketing of mental illnesses and the drugs that supposedly treat them.

Bipolar disorder has become fashionable, with 5 per cent of Americans having some form of the disorder. Now, according to Healy, there is 'a mania for diagnosing bipolar disorder in children.' Some children have been considered to show the first signs of the disorder when they kicked excessively in the womb and screamed when born. (For many mothers, being kicked in the womb might be very uncomfortable but it is evidence that your baby is alive and well.) For adults to be diagnosed as being bipolar they have to be depressed and manic for several weeks in each state, whereas children can earn such a diagnosis by having several changes of mood with each day. (Many mothers would think that, if their two-year-old isn't running the full gamut of emotion every day, he's physically ill.) It is considered unnecessary to talk to the children or to observe the child in a natural setting at home and at nursery. All that is needed is the parents' report on the child. The treatment is with antipsychotic and anticonvulsant drugs. The child becomes quiet and lethargic, in adult terms 'good', but he also becomes fat, and may develop tardive dyskinesia and diabetes, and perhaps drop dead.

Books like The Bipolar Child[iii] and Brandon and the Bipolar Bear[iv] 'are effectively coaching manuals for the condition'. Small children try to please their parents by fulfilling their parents' expectations. If the parents have stressful lives and/or don't know how to look after toddlers (calm atmosphere, constant supervision, lots of cuddles, frequent encouragement such as 'Good girl', 'Well done') they can seize eagerly on something that absolves them of all blame. The fault is in the child.

When a psychiatric patient is prescribed a drug, or a cocktail of drugs, and fails to get better, instead of concluding that the drugs do not work, many psychiatrists complain that the patient is 'drug-resistant'. In their thinking, 'the reason that drugs fail to work must be that the disorder has taken too deep a root. The answer is to start treatment at the first hints of affective instability, no matter how young the child may be'. This may sound like science but it actually is a reworking, albeit unconsciously, of an ancient myth.

Babies arrive in the world being neither good nor bad. They simply are. However, the adults around them immediately start imposing their ideas on them, not just who the baby 'takes after' but whether the baby is, in essence, good or bad. These contrasting ideas form the basis of all our theories about how children should be educated. If children are seen as being basically good, the theory will concern how to draw out the good which is within the child in order to develop his individuality. If the children are seen as being basically bad, the theory will concern controlling the evil within the child and moulding the child into the shape that those in power deem to be desirable. Children who receive the first kind of education tend to be too individual to be predictable, and critical of those in power, whereas children who receive the second kind of education are either rebellious and can be punished, or desirably obedient and uncritical of those in power.

The Christian Church has always favoured containing and moulding the child. Children are 'born in sin', while the Bible warns, 'Spare the rod and spoil the child.' In her book Thou Shalt Not Be Aware Alice Miller pointed out that in our society, a good child sacrifices himself for the parents. In the Bible there is no story of a parent being sacrificed for his child. 'It is always the Isaacs whose sacrifice God demands from the Abrahams, never the other way around.'[v] God-fearing, patriotic Americans, as most Americans are, cannot afford to see parents and society as being at the root of severe mental distress. When children are diagnosed as having a mental disorder, they are being sacrificed, not so much in the name of God as in the name of psychiatry and the pharmaceutical industry.

BBC4 recently broadcast a series of four programmes called 'Inside the Medieval Mind'. The series, presented by the historian Robert Bartlett, concerned 'how medieval man understood the world'. What was implied by the series was that medieval men (and presumably women) saw the world very differently from us. But is this really true?

During the Middle Ages, from the 9^th to the 15^th century, the Bible and the teachings of the Church were the only sources of knowledge. The world was seen to be ordered according to God's plan. Everything that was discovered about the world had to be fitted into that plan. According to the Church, all living creatures belonged to one of four categories: animals, fishes, humans, and spirit beings, which could be angels or demons. Little was known about the lands that lay beyond the British Isles and its nearest neighbours, but that didn't prevent the Church from teaching that in distant lands there were many strange creatures, some of whom are depicted on the 13^th century Mappa Mundi, the map of the world which hangs in Hereford Cathedral. This shows the Dogs Heads, creatures with a human body and a dog's head, which were frequently depicted in medieval illustrations. Everybody believed in the existence of the Dog Heads. If the Church said this was so, it must be so.

In 1253 the Franciscan friar William of Rubruck travelled as far east as Korakorum in Mongolia but found no Dog Heads. On his return, the Pope sent more people to find the Dog Heads, but they were always just over the horizon. Non-sightings didn't destroy the belief in Dog Heads. Two hundred years later, when Christopher Columbus sailed westwards, he expected not only to find China but the Dog Heads too. Lack of evidence didn't destroy the myth.

We wouldn't be so stupid, would we? We're very scientific in our thinking, aren't we? Or are we?

The Medieval Church claimed to be in possession of the truth about everything. The Church punished those who thought for themselves. Thinking for yourself is hard work, so most people were pleased to believe the Church's teaching even when there was evidence to show that the Church was wrong. At the same time, being seen to be in possession of the truth made Church leaders rich and powerful.

In the 18^th century running asylums for lunatics was a profitable business, but in 1845 the Lunacy Act was passed giving doctors the sole right to run asylums. To justify their position doctors invented a host of myths about the causes of lunacy, finally in the mid 20^th century settling on the myth of a biochemical cause, despite the fact that no evidence for this has ever been found. Psychiatrists extended this myth by claiming that psychiatric drugs righted the biochemistry that had gone wrong. On this myth psychiatrists grew rich and powerful.

In her book The Myth of the Chemical Cure Joanna Moncrieff wrote, 

Psychiatric drug treatment is currently administered on the basis of a huge collective myth: the myth that psychiatric drugs act by correcting the biological basis of psychiatric symptoms or diseases. . . There is no evidence to substantiate this view. Instead, the evidence suggests that these drugs induce characteristic abnormal states that can account for their so-called therapeutic effects. . . [This myth] can be viewed as an ideology. . . Like other forms of ideology, it presents itself as an objective, impartial body of knowledge determined only by the facts of the world, whereas it actually conveys a partial view of human experience and activities that are motivated by particular interests. The institution of psychiatry, aided and abetted by the pharmaceutical industry and ultimately backed by the state, has constructed a system of false knowledge about the nature of psychiatric drugs.

Most of the research which failed to find a biochemical cause and which showed that psychiatric drugs did no more than create an abnormal state was done by psychiatrists. Joanna wrote, 'It is as if the psychiatric community cannot bear to acknowledge its own published findings.'

If the world cannot be explained in terms of God's plan but only in terms of science, how can the Church be the only arbiter of what is true and what is false? If severe mental distress cannot be explained in terms of biochemistry but only in terms of how we interpret our experiences, how can psychiatry be the sole arbiter of what is sane and what is mad? No wonder the Church still sees science as the enemy, and psychiatrists ignore the results of their own research. But, if there isn't a biochemical cause of our distress, does that mean we have to take responsibility for ourselves? That we have to think for ourselves? Perhaps the Dog Heads are actually on Mars.