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Understanding our lives in context

Understanding our lives in context

If we are feeling sad it is likely that something has happened that makes us feel sad. It might, for example, be the anniversary of the loss of a loved one. It could be that we have been rejected or let down by someone close to us.

Similarly, there are numerous reasons why we might feel depressed, such as painful memories, trauma or tragedy, a sense of hopelessness, or situations or people that seem beyond our control [more here].

Invariably, it is someone or something that is getting us down. Those people who are on the receiving end of injustice, violence, mental and other forms of abuse will know only too well how this affects their everyday lives. It is also understandable that we become distrustful of others when we are repeatedly let down or betrayed. Thus, how we feel does tend to make sense within the context of our lives.

So whether we feel depressed, stressed, have mood swings, or have more extreme mental or emotional experiences – these tend to correlate in some way with our experiences of life. Any claims that our distress and emotional suffering are primarily the result of disordered brain chemistry (or, to use a popular phrase "faulty brain-wiring") make little sense in the real world of our experiences.

It is true that some physical and/or neurological health conditions can affect how we feel (for example: brain tumour, traumatic brain injury, vitamin deficiencies, hormonal problems) and a doctor’s check-up should rule these in or out as possible causes. But, as mentioned elsewhere in this website, there isn’t any solid evidence to claim that our psychological and emotional concerns are primarily caused by chemical imbalances in the brain. It is also true that people sometimes find it difficult to connect how they feel with the circumstances and events of their lives; though, with time and consideration I find people are often able to make these connections.

     
 
 
 

So whether we feel depressed, stressed, have mood swings, or have more
extreme mental or emotional experiences – these tend to correlate in some way
with our experiences of life.  Any claims that our distress and emotional suffering
are primarily the result of disordered brain chemistry (or, to use a popular phrase
"faulty brain-wiring") make little sense in the real world of our experiences.

 

Although the popular press like to run stories claiming specific genes have been discovered for mental health problems, in reality these seem to be more about wishful thinking than evidence-based science. Research shows that it is common place in published medical studies to exaggerate a genetic link for diseases and the idea that a disordered gene can lead to a disordered mind is far too simplistic, writes the neuroscientist Professor Stephen Rose [More here] – though there are exceptions, such as the depression associated with Huntington’s disease. In the main, genes are not our destiny, and the expression of our genes can be turned on or off, as it were, by life experiences.

Understanding our lives in context does not mean ignoring the findings from genetic research and neuroscience that might shed light on any causes of emotional and mental distress. It does, however, become problematic when these factors are allowed to eclipse the relevance of clues within the circumstances and events of our lives.

I think the complex interplay between social, environmental, genetic and neurological factors is still little understood and it is certainly possible that research will in the future reveal as-yet-not-understood biological factors that impact upon aspects of our psychological well-being. Even so, formative factors such as: the family we grow up in; the schools we attend; the way we are treated; the level of social deprivation experienced; the trauma and distress we encounter; and the relationships we form, will still be key determinants and of primary significance in helping us to understand our lives. And sometimes it is chance meetings and contacts (perhaps a particular school teacher or someone we admire) that prove most pivotal in shaping and directing our lives.

Has society moved on at a pace that far exceeds the ability of some people to adapt?

Living in a fast moving and rapidly changing age is also going to have an impact on our lives. Whilst some people seem to thrive on the challenges of modern day living, others feel overwhelmed and overcome by the stress and distress this brings. In evolutionary terms we have suddenly moved from small, social, shared communities that lived in touch with seasons and land to become much more independent, mobile, and urbanised.  Not surprisingly, some people struggle to find purpose, a sense of belonging and their personal identity in the modern world.

     

In evolutionary terms we have suddenly moved from small, social, shared
communities that lived in touch with seasons and land to become much
more independent, mobile, and urbanised.  Not surprisingly, some people
struggle to find purpose, a sense of belonging and their personal identity
in the modern world.

Some historians have observed that what is now described as ‘schizophrenia’ seems to have increased considerably since the industrial revolution and with the change from rural life to urban living.  In fact, today this diagnosis is more likely in urban areas and among people of lower socio-economic class and among certain immigrant groups 1. Professor Phil Thomas has noted that “The Hutterite and Amish communities, who have successfully preserved the integrity of their traditional eighteenth-century social structures and subsistence agricultural economy, have a much lower prevalence of schizophrenia” 2.

“An ethical, non-exploitative and socially just capitalism that redounds to the benefit of all is impossible”

The sense of alienation, dissatisfaction and despair that many people feel (though often misleadingly diagnosed as depression and anxiety disorders) could be symptomatic of living in an ailing society which is driven by the competitiveness and ruthlessness of a capitalist and consumerist society. 

True enough, capitalism has, for a time at least, raised standards of living and brought job opportunities for many people in the western world. But this comes at a cost: capitalist enterprise progresses by superseding and even destroying what previously existed; just as, for example, corner shops were pushed out by supermarkets and canal-ways declined with the expanse of the railways. This perpetual cycle continues throughout our society; thus, one company’s gain is another’s loss, one person’s promotion is another’s job loss, one family’s security another’s insecurity.  There may be winners, but there will always be losers too.  This is “the creative destruction” that the economist Joseph Schumpeter (1883-1950) clearly foresaw.  As Professor David Harvey has observed: "an ethical, non-exploitative and socially just capitalism that redounds to the benefit of all is impossible. It contradicts the very nature of what capital is about 3." We would be foolish to deny the impact that living in a consumer capitalist society has upon us.

The sense of alienation, dissatisfaction and despair that many people feel
(though often misleadingly diagnosed as depression and anxiety disorders) could
be symptomatic of living in an ailing society which is driven by the competitiveness
and ruthlessness of a capitalist and consumerist society. 

An inherent aspect of financial capitalism is the perpetual creation of new needs: instilling dissatisfaction and converting commodities that we might want into those we must and should have. Thus we are continually bombarded by advertising that seeks to create and play upon dissatisfaction. As the sociologist Professor Bauman writes: “Consumers must never be left to rest” and “need to be constantly exposed to new temptations to keep them in the state of perpetual suspicion and steady disaffection 4." Misinterpreting this as depression and prescribing antidepressants is not going to address the societal de-pression that is a natural response to this. Furthermore, our sense of identity can be closely aligned with the goods we have: the pressure is on to have and to conform.

Like it or not, marketing tries to entice, seduce and deceive us. Working with children, I frequently ponder the impact of growing up in a world like this. As a consumer culture offers the promise of instant gratification, it is not surprising that there is an unrealistic expectation that pills will quickly solve our emotional troubles.

Sadly, I meet many families where one or other parent seems able to move on (sometimes without warning in the middle of the night) – leaving their children as if they are mere commodities and starting off with a new partner and life. Is this an aspect of an exploitive and self-interested belief system – consumer capitalism – whereby relationships can be discarded as outdated commodities?

Market forces and drug promotion – Profits before people

Not only is it helpful to understand ourselves within the context of our lives, it is also helpful to understand mental health treatments within a societal, political and cultural context.

Putting people before profit

The facts show that we can’t believe all that we are being told - big business backed by aggressive marketing can powerfully shape our thinking.  We need our wits about us when it comes to the pharmaceutical industry who “largely control the research agenda, i.e., what gets done as research and what gets reported in the journals and they suppress what is contrary to their constricted self-interest 5." The drug companies are there primarily to make a profit and our healthcare (including our mental and emotional well-being) is not necessarily their priority.

As Professor Valenstein writes: “Pharmaceutical companies almost always exaggerate the effectiveness of their drug while tending to minimise their adverse side effects.” This is done by selectively citing the best results “and by placing their own ‘spin’ on the way the data is presented 6." As we take the opportunity and time to understand our lives in context, it would be naïve to assume that all the medicines (including those for mental health concerns) are as safe and effective as we had hoped. We need accurate information to weigh up the risks. Unfortunately even our doctors are largely reliant on information that is doctored by the drug makers.

Professor Tim Kendall, joint director of the National Collaborating Centre for Mental Health, points out that "In mental health 85% of all published trials are funded by the drug industry 7." It is also recognised that drug company promotional literature (and bias) influences doctors’ prescribing much more than they realise and “they often use it as a source of information about new medicines 8." 9, 10.

Guardian columnist Dr Ben Goldacre summarises some of these key concerns in an interview for The Economist: “Pharmaceutical firms routinely bury unflattering trial results and publish only the good ones. Those trials are run on unrepresentative patients, with dodgy statistical analysis, and then pushed on doctors with advertising budgets that are often bigger than those of the firms' research-and-development arms. Meanwhile, medicine’s guardians—the regulators, the scientific journals, the professional bodies and the academic establishment—either collude with such practices or turn a blind eye. The net result is that doctors must prescribe in ignorance, patients are harmed, and vast amounts of money are wasted 11."

Beginning to understand our lives within their social and cultural context is a good place to start

As we have seen, our lives are largely shaped by the people and culture in which we live. I realise we have barely touched the surface and there are many more questions that could be asked, for example: what is it like to be a woman in such a male dominated society? What is the impact of growing up in a minority group? What about our society's preoccupation with slimness and body image? These and many other matters lead to issues that are often inappropriately diagnosed as if there was some failing or deficiency within the person rather than within our society.

The fact that prescription drugs are poorly regulated and that the drug industry is known to be economical with the truth (their track record is reflected in the multimillion dollar fines against then, see here) leaves us uncertain as to the safety and effectiveness of the mental health drugs on offer through our doctors. Personally, this makes me very cautious and supports the need to search out reliable research data that is, as far as possible, independent of the drug industry.

Of course there are other commmercial interests that influence our lives and thinking. The parenting industry is marketing an over-simplified and sometimes unrealistic view of raising children that is popularised by TV programmes.  As with much of the rest of modern life, parenting is reduced to a series of problems to be solved and techniques to be mastered. The wider picture and the subtleties of relationships are often missed.

The jury is out regarding the impact of genes and brain chemistry on emotional or mental distress and disturbance. What is beyond dispute is that the cutural, social, ethnic (including discrimination), familial, interpersonal and economic circumstances (social inequality included) of our lives have an enormous impact on our mental and physical well-being. More specifically, injustice - including various forms of abuse - may have been experienced.

In reality, our lives are largely shaped (and miss-shaped) by our experiences of life. Drugs (prescribed or illicit) can't mend the hurts of childhood violence and abuse, or the circumstances that surround the anxiety, stress and distress of modern-day living. But if we have (incorrectly) been told that our emotional and psychological concerns are caused by chemical imbalances in the brain [more here], we are less likely to seek out and discover other ways of finding balance and greater harmony in our lives.

I recognise that as a society we have a tendency to favour medical explanations for our mental and emotional concerns. As the evidence supporting this approach is poor, maybe beginning to understand our lives within their social and cultural and everyday context is a good place to start.

References - Bibliography - Further reading

1 Psychiatric Imperialism: The Medicalisation of Modern Living. Academy for the Study of the Psychoanalytic Arts. Full article available here

2 Thomas, P. (1997) The Dialectics of Schizophrenia. UK:Free Association Books

3 Harvey, D. (2010) The Enigma of Capital and the Crisis of Capitalism. London: Profile Books Ltd

4 Bauman, Z. (1999) The Self in a Consumer Society.

5 McHenry, L. (2008) Biomedical Research & Corporate Interests: A question of academic freedom. Mens Sana Monogr. Jan - Dec 2008, p146-156. Full article

6 Valenstein, E.S. (1998) Blaming the Brain: The truth about drugs and mental health. New York: The Free Press.

7 The Guardian

8 WHO Dept of Essential Drugs and Medicines Policy (EDM) and Health Action International (HAI). (2004) Drug promotion: what we know, what we have yet to learn.

9 Lexchin, J. et al. Pharmaceutical industry sponsorship and research outcome and quality: sytematic review. BMJ Vol 326 2003. Full article

10 Brodkey, A.C. (2005) The role of the pharmaceutical industry in teaching psychopharmacology: a growing problem. Academic Psychiatry 2005; 29:222-229. Full article

11 The Economist

 
 
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