We’ve come a long way in how we think about mental health over the last few decades. It seems incredible that back in my childhood of the 1970s and 80s Victorian asylum-style institutions remained the primary treatment route for people with psychological problems. At the risk of being political, it was not until 1997 under New Labour that treatment shifted from hospitals to the community and focus began to turn from mental illness to mental health.
I was five in the early 1970s when my father died and we entered an era of silent suffering in our house, with no words and no support structure to help us navigate what followed. Many years later, my devastation for those two young princes walking behind their mother’s coffin was particularly acute. As Prince William himself has said, they are members of a club that nobody wants to join.
In a world without words, books helped me make sense of some of my own experience. Having often thought of myself as abnormal, isolated on my own island of unspoken grief, through reading I discovered a fellowship of suffering out there. In God of Small Things, Arundathi Roy used her fascination with black holes to conjure up her character’s response to loss – “A Joe-shaped Hole in the Universe” - giving a name and tangible feeling to the enormous father–shaped void at the centre of my world. Dave Eggers brought into the light and made more bearable my recurrent middle-of-the night fears about my own mortality that have plagued me for as long as I can remember. I was no longer alone:
“…whatever there might be out there that snuffs out life is probably sniffing around for him, that his number is perennially, eternally up, that his draft number is low, that his bingo card is hot, that he has a bull's-eye on his chest and target on his back. It's fun. You'll see.” (A Heartbreaking Work of Staggering Genius)
Things have moved on and thanks to the likes of public figures such as Ruby Wax, Stephen Fry and Alistair Campbell, we can see our suffering mirrored in the public expression of these celebrities’ imperfect selves. It can be very comforting. Even royalty, with the stiffest of British upper lips, have – since the death of Princess Diana – become increasingly willing to expose their psychological struggles. So, it was no surprise to see my fellow traveller in grief express very similar feelings to my own last week. Prince William described how for him death always seems “just around the corner” and spoke vividly of the particular pain of losing a parent so young. Yet, if they seem like simple words to utter, and Prince William has a natural, relaxed demeanour when he talks, make no mistake that “a pain like no other pain” is difficult to feel let alone speak out loud. Sorrow and vulnerability are not blunted by privilege, and I’m sure that his array of powerful emotions often felt overwhelming and very far from normal. His bravery and candour in talking about them in front of cameras to a massive audience are truly admirable.
Whilst there are visible improvements in how we think about and tackle mental health, there is room for improvement. Statistics show some interesting gender-based differences. Women are more likely to be diagnosed with mental health problems than men and 10% of mothers are experiencing them at any one time, versus 6% of fathers. In contrast, suicide rates are around three times higher in men than women (78% of suicides are among men). Despite increased focus on men’s mental health, this differential persists and has existed for as long as data on deaths by suicide have been recorded. The reasons for it reveal the damaging consequences of stereotyping of men and women. Men feel pressure to be strong and still find it more difficult than women to talk about their problems. At the same time they seem to be more susceptible to money worries (perhaps a hangover from pressure to be the provider). Men often focus on their careers over their relationships and can find themselves more isolated as they grow older. All of this too frequently prevents men seeking the help they need to carry on.
Prince William wants to change the way men think and talk about their mental health. This is an admirable aim and his Foundation’s work has contributed to a marked increase in awareness. But sometimes just recognising you have a problem and talking to your family or friends are not enough. Processing them with the help of a professional becomes a necessity. Freud described his work not as talking therapy, but as “listening.” How you are heard matters. The increasing numbers of people now looking to be listened to by mental health professionals in the UK are likely to face long waits before they can get access to the therapies they need. The NHS has said that it cannot meet the country’s mental health service needs alone.
Other solutions may be at hand. Technology is often seen as the enemy of mental health with its addictive qualities and the uncensored, isolating nature of online communications. Yet, this modern equivalent of Freud’s “blank screen” offers as yet unexplored opportunities for service provision. Using your mobile as a therapeutic listening device might offer a more accessible and cost-effective route to better mental health which men (and many women) would find easier to engage with and integrate into their daily routines. This is my hope and the rationale for the new tryfreemind.com project which I am part of, looking at how the processes Freud devised can be re-invented for the virtual world.
Despite the challenges increased demand for mental health services bring, we should celebrate the progress we are making in recognising our imperfect selves as the new normal and bringing them into the light. It is a big step forward.