We need to weep over the wreckage of mental illness

While its now OK to talk about mental illnesses, we need to weep over the harm caused and how we’ve tried to treat them, writes Rachael Newham.

Rachael Newham

Rachael is an author and theology of mental health specialist.

A grey and white wall graffited with a tag a image of a person crumpled and crying.

Today, February 1st, is Time to Talk Day. It's part of a long-running campaign encouraging people to have open and honest conversations about mental health. It's aim is to break down the barriers of stigma and misunderstanding. It has been a staggering success - what was a fringe issue talked by those only affected by mental illness a decade ago is now part of common parlance. Mental health training is widely available, and the charity’s work has been seen to have a significant positive impact on the mental health conversation

However, as our familiarity with the language of mental health has grown so too has the way we use it. People might talk about having PTSD after a bad date, or their friend being ‘so OCD’ about the way they organise. Unwittingly, as psychotherapist and author Julia Samuels points out, “[we have] awareness without real understanding.”

However, awareness without understanding means we actually don’t reach those most impacted by mental illness. We know about mental health in the way we know about our physical health - but we are no more aware about the serious, sometimes lifelong mental illnesses which rob people of hope, joy and vitality - sometimes leaving them with lifelong disability.

If you ask most people about mental illness they may tell you about depression and anxiety; the two most common mental illnesses which have become the acceptable face of mental illness. It’s reflected in the way funding is channeled to interventions that get people with mental illnesses back to work, or to NHS ‘Talking Therapies’ which offers short term psychological therapies (both of which are important initiatives) but have cut the number of inpatient beds from over 50,000 in 2001 to under 25,000 in 2022[3] which means those at the more severe end of the spectrum of mental health to mental illness are left to travel 300 miles for the care they need.

We have to survey the wreckage that severe and enduring mental illness causes, before we can begin to rebuild a society that is kinder - without prejudice or stigma.

Whilst it’s right that we have raised awareness about the most common conditions, we can’t ignore the illnesses which are termed ‘severe and enduring mental illnesses’ which include those such as bipolar disorder, major depression, schizophrenia and complex post-traumatic stress disorder.

For people living with these conditions, the general mental health advice that we give; for example getting enough sleep and time outdoors may not be enough to keep the symptoms at bay. Just as general physical health advice like getting your five a day will not cure or prevent all severe physical illnesses. Medication, hospitalisation, and at times even restrictions of freedom like being detained under the mental health act might be necessary to save lives.

These are stories that we need to hear. The debilitating side effects of life saving medications that can raise blood pressure, cause speech impediments. The injustices to confront (such as the fact that black people are five times more likely to be detained under the mental health act than their white counterparts) and the adjustments to life that those with disabilities are required to make to their lives.

We have to survey the wreckage that severe and enduring mental illness causes, before we can begin to rebuild a society that is kinder - without prejudice or stigma. We have to listen to the perhaps devastating, perhaps uncomfortable stories of those who live with severe and enduring mental illness. The mental health npatient units miles from home, the lack of freedom, the searing - unending grief.

Weep for the lives lost, the crumbling systems, the harm caused both by mental illness and the way we’ve tried to treat them.

By hearing these stories, we are accepting them as a part of reality. For those of us in churches it might be that the healing didn’t come in the way we expected, it might be also be all of us accepting that the systems designed to care for those with mental illness have in fact, caused more harm. It’s seeing the injustices and understanding that we, our systems and professionals need to change our attitudes.

Understanding and acceptance of the injustice are the way forward- that’s the only way change can come.

It might look like standing in the rubble, it might feel too huge and all but hopeless.

And yet in scripture and in life that is so often the only way we can begin to rebuild.

In the book of Nehemiah, one of the Old Testament prophets who had lived in exile far away from home for his whole life, we see that upon hearing about the state of the walls of Jerusalem, before he did any of the things we expect heroes and innovators to do- he wept. In fact, it’s estimated that for four months he wept over the state of the place that had once been the envy of the ancient world.

Perhaps we too need hear the stories and then weep.

Weep for the lives lost, the crumbling systems, the harm caused both by mental illness and the way we’ve tried to treat them and then slowly, we can begin the work of rebuilding.

It isn’t a work that can be done alone by a single agency much less a single person - it requires society to hear stories of the more than just ‘palatable’ mental illnesses with neat and tidy endings to the messy and sometimes traumatic stories that are there if we just care to listen to them. It might be reflected in the petitions we sign, the way we vote, the stories we choose to read.

So ,this Time to Talk Day - I’m saying let’s continue the amazing work of talking about mental health - we need to keep talking about anxiety and depression. But let us also make conversations wider, so that they encompass the whole continuum of mental health and illness.

We’ve seen the difference Time to Talk can make - now it’s time to talk about severe and enduring mental illnesses, too.

Column

Assisted dying

Comment

31 July 2024

4 min read

Polly's pop at a "pitiless God" distorts my argument

There’s more than one argument for opposing assisted dying.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A hand rest gently on another outstretched hand.

Alexander Grey on Unsplash.

I hesitate to have a pop at the venerable Guardian columnist Polly Toynbee, partly because I like and admire her work. And partly, in this new media environment in which my enemy’s friend is my troll, I fear aligning myself with foam-flecked righties who use words like “Guardianista” and “wokerati”.

But she wrote a column late last week about assisted suicide that was just plain wrong. And, actually, I think she’s being profoundly illiberal on the subject, for reasons I’ll explain in a moment.

Assisted suicide – voluntary euthanasia, assisted dying, call it what you will – was a hobby horse of mine some 15 years ago when I wrote a book against it. Slightly more recently, Toynbee and I were on a broadcast interview together on an entirely unrelated subject when, to the bemusement of the presenter, she suddenly raised assisted dying to have a go at me. It was quite flattering.

Anyway, last week’s Toynbee column was of a kind, dismissing the anti-euthanasia case as the province of religious nutcases (presumably like me). Consider this massive straw man of a sentence: “Only God can decide how long we should suffer before death comes at a time of his pitiless whim, they say.”

I’m used to this, though not from Toynbee. Debating assisted suicide, it’s only a matter of minutes before someone will say that I shouldn’t impose my “sanctity of life” beliefs on other people. Eh? I’ve never used that phrase in this context (whatever it may mean). In fact, my views on assisted suicide are entirely secular, though informed by a faith that respects the primacy of compassion for and defence of the most vulnerable in our society.

I believe that a jurisdiction that enshrines in its legislature the principle that some lives are more worth living than others takes us into very dangerous moral territory. Related to that, a two-tier structure for the value of human life in the medical professions is abhorrent. That’s why I say that to despatch the weakest and most vulnerable among us is unacceptably illiberal.

The terminally ill, the disabled, the profoundly depressed and the aged and vulnerable really shouldn’t be treated as a nuisance to be helped on their way.

A bill will come back to parliament to change the law to allow assisted suicide this autumn. With new PM Keir Starmer in favour and a very different configuration of the House of Commons post-election, its chances of passing are said to be high.

But even Lord Falconer, the parliamentary poster-boy for assisted suicide, who convened a ludicrous “independent” commission in 2012 stuffed with euthanasia enthusiasts and useful idiots, has accepted that no so-called safeguards can entirely ensure that no lives will be lost to malfeasance or malpractice.

So, my question to Falconer and Toynbee is this: How many unnecessary lives lost to assisted suicide is enough to have what you want? 100? 50? One? Another number?

It’s commonplace for deeply distressing accounts of agonising deaths to be rehearsed in support of assisted suicide. Toynbee did so last week. But as Falconer must (or should) know, hard cases make bad law. The only focus here should be on how best to ensure that no one need die a bad death.

For Falconer and his supporters the solution is to legislate so that terminally ill patients can be helped to kill themselves. But speaking to end-of-life medical professionals, such as Baroness Finlay of Llandaff, many of whom claim that advances now mean that bad deaths are vanishingly few, it’s clear that the UK’s world-leading palliative care has in sight the day when no one need die a bad death.

That’s no comfort to someone who is suffering at the end of their life right now. But assisted suicide puts that palliative care target in jeopardy, when it makes death a form of medical treatment. Look at the record – the Netherlands now allows assisted suicide for those who are simply “tired of life”. That’s not where end-of-life care should go.

The burden of proof under the Suicide Act (1961) lies with the defendant, who currently faces a maximum jail sentence of 14 years for assisting or encouraging a suicide. Those who have demonstrated that they have acted with compassion and consent have in turn been treated with compassion and leniency in the application of the law. Invert that burden of proof, with the Crown needing to prove that an unscrupulous relative or friend coerced a victim into suicide, and we’re into a fresh hell of moral jeopardy.

The law works as it stands. The terminally ill, the disabled, the profoundly depressed and the aged and vulnerable really shouldn’t be treated as a nuisance to be helped on their way. Again, as we might expect Toynbee to know, that is wholly illiberal.

It looks like the assisted suicide lobby will get what they want this year. It will be hailed as a great liberal social reform. Doubtless they will find it in their hearts to forgive me if I continue to demur.