Column

It’s time mental illness took a holiday

Say you’d asked a class of thirteen year-olds to prepare five-minute speeches on the holiday they’d most like to take. How would you feel if each read out reasons why staying at home is bad? Say you’d asked them what excites them, and they came up with ways to avoid anxiety. Say you wanted to hear about happiness, and all they could tell you is you shouldn’t get depressed. How would you react?

You wouldn’t believe it. You’d pinch yourself and expect to wake up. Ask children about holidays and they’re bound to talk about the joys of the destination. Ask kids about happiness and they tell you what makes them happy — they give you examples, they describe their excitements, they paint pictures of what is good.

But wait just a handful of years. See the kids past A-levels, through medical school and into psychiatric training — then ask them again. Ask them what’s exciting. Ask them to depict happiness. Ask them to define mental health. They won’t be able to answer you. In fact most of them won’t understand why you’re asking the question.

Over the years I’ve taught hundreds of psychiatric registrars. Each time I ask them for a definition of mental illness (and I always do) they look at me as if I am stupid (does he think we don’t know? doesn’t he know?) and then recite from their diagnostic manuals. Whenever I ask for a definition of mental health there is silence. They don’t know what I’m asking for, and haven’t a clue how to respond.

I recently invited six mental health professionals to speak for five minutes on ‘the value of mental health’. Five gave a lecture on the problem of mental illness. Two of them didn’t even mention mental health, despite explicit instructions to do so.

What happens between schoolroom and post-graduate tutorial? What treachery turns teenagers instinctively aware of life’s positives into young adults unable to conceive of mental health? A class of school children unable to imagine a good holiday, a fulfilling game or an exciting experience would be unthinkably tragic. So why do we honour such outlandish myopia in professionals in their mid-twenties?

There are plenty of reasons why mental health professionals can’t articulate mental health. Trainees absorb classifications of illness not health, they deal with problems so severe that achieving equilibrium is usually as much as they can hope for, and they are therapists not sages after all. But traditional emphasis on alleviating negatives should not make it impossible to set out positives.

Different holidays appeal to different thirteen year-olds. Different experiences excite them. What makes one teenager happy may even make another sad — whereas an illness is an illness (or so we are told).

But if thirteen year olds spontaneously talk about happy holidays twenty six year olds should at least be able to contemplate what happy thinking might be. If enough thirteen year olds describe enough good holidays patterns will emerge, and knowledge of these patterns will help in planning happy holidays for future thirteen year olds. Exactly the same could be true of mental health — if only mental health professionals could talk about mental health properly.

We are a long way from this, but we can begin to improve things by changing our expectations of professional education.

At the moment we teach professionals to become technically competent, assured and confident. We must continue to do this, of course.

But as we do so we must take the greatest care to preserve the fervour of youth. Instincts destroyed are gone forever. Yet foster the child, and anything is possible.