Half measures
Why the doc is only 50% of a doctor
"Doctor, doctor, I think I'm going crazy."
"I think you might be right, sir, for this is a supermarket."
It's an old joke, but it still makes me chuckle.
And yet it's no laughing matter when real-life physicians are no more helpful than the check-out assistant at Tesco.
There are two immensely frustrating things about mental health services in the UK. The first is that they don't really exist, not in any reliable, universal way. Many new arrivals in the vale of woe are told to wait for several months, or even years, for a psychiatric evaluation or therapy. It's the equivalent of telling a pregnant woman that her first baby scan will happen after 284 weeks. Those who can afford it go private. It’s wickedly unfair. And my hunch is that despite its current Mental Health Bill, the Labour government will not deliver much improvement: the crises in hospital capacity, social care, and cancer waiting times will remain priorities, simply because they are more visible.
The second frustration is that for some unfathomable reason, western medicine likes to divide physical and mental health into two separate fields. Ask a psychiatrist whether your depression might have been caused by an infection like flu or Covid* and you won’t get very far. They will likely tell you that even if it was, they can’t do much about it. Many people with Long Covid, ME, CFS and other post-viral complaints are left in limbo as a result, with no idea as to how to avoid future episodes.
Similarly, if you ask a physical doctor - an orthopaedic surgeon, say - whether your frozen shoulder might have something to do with your anxiety and you'll probably be met with a shrug (his shoulders are better than yours) and suggestions of steroid injections.
This makes no sense. It is like having a dentist who only looks at your molars. Or a waiter who only brings half your food (“you’ll have to make an appointment with our vegetable specialist to get your greens.”)
I wanted to get the perspective of someone who treats the whole organism as one, so I spoke to Simone Regina Adams, a psychotherapist who lives and practices in southwest Germany.
“It makes no sense to say this is psychological or this is a bodily experience,” Simone tells me. “The body is an information system. Whatever triggers your system can cause several effects.
“A physical trigger can set off a psychological chain reaction. And the other way round: a psychological trigger can set off a chain of physical reaction.”
Simone says she sees clients with all kinds of unclear, unexplained symptoms - following Covid**, for example, or after a vaccination or a car crash or a host of other potential triggers that you might call ‘life’. “I try to reach the unconscious information system with them, so to speak. And then we try to go from information to meaning.
“In the end, we are not only an information system, but a meaning system - we need meaning in life.” For more about Simone’s work, visit metameaning.com.
The problem with the dualistic approach is that patients are treated as a collection of parts that do not interact, rather than as a complex, interconnected system. It also means that mental health is relegated to a sideshow, where funding, treatment and research are all paltry by comparison with physical health. This excellent piece by my former colleague Aida Edemariam delves more deeply into the issue.
I’d love to hear from readers who have fallen foul of this dualistic system - and medical professionals who operate within it. Why are physical and mental treated so distinctly? Are there any solutions?
After all, a threadbare and overlooked mental health system, divorced from the physical and shunted into unloved sidings, is no laughing matter for the millions of people who need it.
* Thanks to Carole for this link
** Thanks to James for this link
Great article exploring a glaring issue in our attitude to healthcare. I would suggest there is a third issue which affects psychology (and western society at large) as a whole and that is a hyper-focus on the individual. While each person has their own unique needs and circumstances, it is the isolation of the individual from their context in entirety that plagues much of psychology. If you’re interested I would direct you to look at Participatory Action Research approaches to research methods in psychology. This approach, in short, places the individual back into their larger context and community and attempts to facilitate their healing and growth in this context. It’s still quite a niche approach, but i fell in love with it my final year after feeling a lot of the issues mentioned in your article. Thanks again for a great read!
Such a good article on such an important topic.