Self’s senseless view of mental illness

Admittedly, I’ve never been a fan of Will Self. But I approached his recent Guardian article on mental illness with an open mind, and hoped it would be a worthwhile piece. Unfortunately, I was wrong.

He argues that there has been an “exponential increase” in the use of antidepressants. I scratched my head at this.  Assuming there’s genuinely been a rise (which is far from certain), why would it even be an issue? The use of antidepressants has made life easier to deal with for those for whom they work. They don’t work for everyone, but Self should be encouraging people who feel depressed to go to their doctor and explore treatment options, rather than call into question the efficacy of those options.

Regardless, the true flaw in the argument lies in the numbers. There has indeed been an “exponential increase” in prescriptions, but Self’s choice of words make it sound like that’s the same thing as a rise in the number of people using them.

As Ben Goldacre, an alumnus of Magdalen and a writer well worth reading, would tell you, a 2009 BMJ paper found that a major cause of the last decade’s rise in antidepressant prescriptions might well not have meant more people are going on the drugs. In fact, the figures more likely reflect an increase in people receiving long-term treatment on repeat prescriptions, a phenomenon that knocks the statistics up and generates the headline figures we see. It’s also worth remembering that doctors prescribe antidepressants for a wide variety of mental and non-mental conditions, including hot flushes and post-traumatic stress disorder, something that also shakes up the numbers.

As the article progresses, it is hard to avoid the conclusion that Self has a hidden agenda. He suggests that there has been an increase in the number of mental illnesses listed in the books that doctors use to diagnose mental illnesses and prescribe drugs – the DSM and the ICD. So far, so true. But he also suggests that this has taken place so that psychiatrists, in some wild collusion with pharmaceutical companies, can “conquer…new worlds”. In other words, the “new” mental illnesses are pawns in the business plans of drug firms. At this point, I had to stop, look, and re-read. Does a conspiracy have to explain everything? Or could the rise in recognised conditions simply be the result of the increased understanding of mental illness?

Sadly, that straightforward idea doesn’t fit into Self’s worldview, so it’s knocked out of the window. As an ex-intern at a mental health charity, I’ve had a fair bit of experience with the DSM, and many of the “new” mental illnesses (or mental illnesses that have always existed but have only recently been understood) that are newly listed in the most recent edition are not even treated with the products of “big pharma” – except in the most severe cases. Hoarding disorder, for example, is a “new” one, and that’s treated in the first instance by talking therapies like cognitive behavioural therapy, as is binge eating disorder – two very difficult conditions to live with that are certainly real. Nobody except the most naïve are denying that pharmaceutical companies are in it for themselves, but the only reason that disorders like these are in the DSM are because they exist in the way they’re described and need to be cured.

The worst part of this article is the question that opened the print version. “Are we treating sad people as though they were mentally ill?” is a question frequently asked in one form or another by authors with deservedly unsavoury reputations when it comes to mental health. For some reason, Self’s question seems to have gone unnoticed. He is essentially just pushing the all-too-familiar lie that some of those treated for depression don’t really have the illness, and it is truly sad that he seems to have got away with it. Stigma is stigma, and no matter who is pushing it, it should be challenged and exposed.