October 16, 2014

A certain kind of conformity

By Rachel Nolan
A certain kind of conformity
The conversation about mental health that Australia has to have

I have to say it. I have had it up to here with the mental health bonanza currently running on the ABC. They promised a week. It’s now in its second. If the network carries on like this, I’ll be driven quite up the wall.

I know it’s un-PC to say it, and that doing so invites condemnatory rage. I know my sensitive friends will be offended and that it’s a big, perhaps cruel leap to critique the earnest work of people who obviously care. I appreciate that good comes of mental health week – our troubles are better out than in – but if I hear one more touchy-feely platitude I’m going punch the radio. I can’t stand it any more.

It’s not that I don’t care for suffering. It’s that I’m convinced we’re coming at it from the wrong end. I fear mental health week represents group think, a medicalisation of the human condition, the pursuit of which brings its own pain.

The different view I hold has been building inside me, stewing away in both heart and head for at least the last seven years.

That long ago I was a member of the Queensland Parliament, a newly minted Parliamentary Secretary for community and welfare services. At short notice, I had to give a major speech about suicide prevention at the Brisbane City Hall.  It being a last-minute thing, I deviated from my usual practice and relied heavily on my department’s turgid notes.

The speech I gave was about the state’s suicide-prevention strategy, a document the government had earnestly launched a few years before. Even as I spoke, though, I felt there was something hollow in all of this. It had the usual stuff – more money for beds in the state’s dreadful mental-health wards, funds for community services to provide counselling and an overriding commitment to awareness raising. It’s the same earnest but unconvincing formula we hear from the Pat McGorrys of the world now. 

But it’s a strategy for individual problems, not one for a much broader social phenomenon. A key target audience for the strategy was the usual-suspect cohort of rural men – then, as now, older men were shooting themselves, younger ones were unbuckling their seatbelts and driving their utes headlong into trees. And while we funded awareness raising and counselling at community services in the bush, there was nothing about why these men were killing themselves. We were saying nothing about the crippling burden of debt caused by scandalously overpriced marginal rural land, or the crushing conformity of the blokey culture that so dominated the lives of young rural men.

Now, all these years later, this essential conundrum at the heart of mental health week bothers me still. A medical model of mental health individualises the problem, taking the first step of saying it’s OK to talk about it but does nothing to encoureage a broader social dialogue about what lies beneath.

The underlying premise of the mainstream mental-health movement is that 20 per cent of all Australians suffer from a mental illness in any given year, or, understood differently, that half of us will go through that experience at some point in our lives. Mental illness, we are told, is an epidemic in the western world.

At even a moment’s pause, it’s a shocking statistic. But take a step back, and consider it as we might do an unemployment figure from the ABS. Are we really in that bad a way? Are those in that 20 per cent figure medically – diagnosably – "mentally ill"?  Or are they just sad or going through the normal tumult of life? The number deserves to be challenged because at its heart is questionable science. Mental illness is diagnosed by analysing behaviour and by questionnaires assessing self-described emotional states. There is no objective test.

For the mental health industry, the number serves a purpose, bringing a legitimacy – and government attention – to a previously marginal problem. Once in the realm of government, though, the number creates huge public policy problems. How can we possibly provide services to such a large number of people? Without refinement – which must be based on hard data – the number becomes an impediment. It can make the mental health problem seem overwhelming, insurmountable.  

The solution to the public policy problem must begin with evidence and with a serious effort to break the problem into its component parts – to separate acute mental illness (psychosis, schizophrenia, bipolar disorder, clinical depression, post-traumatic stress disorder) from the lower-level social afflictions (stress, depression and anxiety) that afflict so many of us. While the two are mixed together, we are caught in a directionless public debate, never properly defining the problem we’re trying to fix.

Separating the two – and acknowledging the grey area in between – is a critical first step in addressing the problem. It creates the room to have an honest, informed debate about the genuine under-resourcing and poor coordination in the acute mental health sector, which is a debate best carried out by clinical experts in the field. But it also creates room for a discussion about the rest: an honest conversation about what’s afflicting our society, about why so many of us report the stress, depression and anxiety now categorised as poor mental health. This, in my view, is a social more than a medical phenomenon. What to do about it is the conversation that Australia has to have. 

* * *

Recently, I travelled overland across half the world, from Europe to Indonesia (excepting warzones). I was by no means contemplating mental health, but I was struck by different cultures’ attitudes to life and how happy or otherwise the people around me seemed to be.

The journey started in Ireland, a place where melancholy runs deep, and continued through France and Germany, countries in which everyday discussions about life carry a deep philosophical streak. In southern Europe, where the economic state created a situation of genuine social distress, there was hardship, sadness and suicide, but there was also something Australia lacks: the concept of la bella vita: a good, beautiful life. In the Middle East there was religious schism I won’t delve into here, and in India and South East Asia, the hardest of lives were met with communal values and principles of acceptance, a prevalent philosophy of simply getting on with it.

The Australia to which I returned shocked me. We were oblivious to our good fortune – complaining and beset with a sense of entitlement. On my first visit to a suburban Westfield, the shopping centre behemoth that has become Australia’s gift to the modern world, I felt physically overwhelmed by the atmosphere I found there. The people gathering in the food court looked blank and unhappy and I was struck by incomprehension at how it was possible for the shops to sell all this stuff.   

Everywhere I went in my first months at home, I was shocked by what I perceived as Australia’s prevailing values: consumerism, individualism, tribalism and competitiveness. I came to see our society as one that has tumbled into a vast spiritual void. 

It seemed that all around me was the promotion of values I didn’t share: money, material possessions, celebrity, youth, beauty, a fixation with romantic love. The problem with these things is that they make for tough ideals – most of us don’t possess them, for most of our time. 

These shallow, narcissistic values were promoted in popular culture through the scourge of reality TV – The Block for status and materialism, The Bachelor for youth, beauty and romance. Alongside them sat MasterChef, promoting the abominable concept that good food somehow equates to a meaningful life experience.

The Murdoch press launched daily attacks on those who didn’t fit this mould from niqab-wearing Muslims, to transgender people, to the Greens. In a similar vein the prime minister launched "Team Australia", a concept Sean Micallef skewered when he described the team as playing against our enemies – refugees, terrorists (or perhaps it was Muslims?), unions. In such a tribal world we all suffer from the absence of leadership. Tony Abbott is not the sort of leader who will ever appeal to the better angels of our nature. 

The dangerous thing, apart from its evident nastiness, about this prevailing culture is its hard line projection of a certain kind of conformity. Those who belong are young, successful, good looking, popular and rich. Heaven help the rest of us left to conclude we have failed.

In his extraordinary book 1998 Romulus, My Father philosopher Raimond Gaita explores the tragedy of his own mother’s life. Describing this woman who drove her partner to suicide before later killing herself, Gaita contends that while she did indeed have a psychological illness, the attitudes of the time clearly played a part. “For someone like my mother, highly intelligent, deeply sensuous, anarchic and unstable, this emphasis on character, given an Australian accent, provided the wrong conceptual environment for her to find herself and for others to understand her. It was emblematic of a culture whose limitations were partly the reason she could not overcome hers.”

The prevailing environment, the social values of the time, are the context in which we all seek happiness. When those values are the wrong ones – shallow, uncharitable, conformist, unobtainable, lacking compassion and plain nasty – is it any wonder at all that so many people feel burdened by a weight of unhappiness?

* * *

This is exemplified best by the mental illness of the moment. Anxiety has overtaken stress as the most common mental affliction, but what else is anxiety if not a gripping fear of the gap between expectation and reality?

Most spiritual traditions deliver similar messages about the path to a meaningful life – value peace, exercise compassion, engage in prayerful reflection, do unto others as you would have them do to you. Courage, wisdom, justice, restraint, love, hope and faithfulness are among the highest Christian values proposed by Augustine. In its very different way, Buddhism promotes a different but deeply beautiful message that kindness and reflection light the path to enlightenment.

The medical model of mental illness, for all its pseudo science, fills some of the space once occupied by organised religion. While it has merit, bringing unhappiness into the open and providing a place to go for people who need help, its two key tools – drugs and counselling – are gravely limited as solutions to relieve our suffering. As Karen Hitchcock has written recently in the Monthly, most clinical trials of antidepressant drugs rate them barely above placebos in their effectiveness. While counselling can help people by providing a caring ear, cognitive behaviour therapy – the approach currently in vogue – encourages people to think differently about the situation they are in. It does nothing to address the social context that is so often the root of the problem.  

And while we measure our internal turmoil against the air-brushed, Facebooked standards of a shallow social media world, the essential problem of conformity is that none of us fits in. We never will.

The magic of the modern condition is individuality – the purpose of a good life is to be our truest selves, a rocky path if ever there was one. But when we medicalise the sadness and the grief that come along that way, we say it’s an individual problem that needs to be treated, not a journey we all travel together, a burden we share.

So if we’re to talk about our collective sadness, let’s talk about the values that prevail today. Let’s rage against them, take our own country back – reclaim our Facebook pages, our families, our newspapers, our TVs and our friends. Let’s collectively accept our individuality, and accept that none of us fits the mould. We are on a quest to understand our differences – to create, not just to find, our fullest, truest selves. It’s a difficult journey. “Life wasn’t meant to be easy, my child,” George Bernard Shaw told us long ago, “but take courage, it can be delightful.”

Rachel Nolan

Rachel Nolan was a member of the Queensland parliament from 2001 to 2012 and minister for transport, then finance, natural resources and the arts.

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