Making Your Anxiety Our Business

The mental health landscape

The latter opened the discussion with an evaluation, from a psychologist perspective, of the contemporary mental health landscape. 

In the view of Dr. Roberts, what constitutes the on-going mental health crisis cannot be disentangled from the deteriorating social and economic well-being of society. It goes beyond the problems people face. “The system that’s been in a sense where people turn for interventions which have been predominately a kind of medical, biomedical framework, doesn’t work”, says Roberts, who adds:

“The evidence base has been stacking up in the last few years that the drugs don’t work. Not just that they don’t work – or where they do work it’s kind of a placebo effect. Long term use on them is harmful. Studies looking at them, that have reportedly been beneficial, are being funded by Big Pharma and have been engineered to produce spurious good looking results.”

But, isn’t it the case that for many people with mental health issues, the drugs do work?

Not according to Dr. Roberts who insists that the biomedical model has not delivered. “People who do have psychological issues [when asked] generally prefer psychological interventions such as psychotherapy, cognitive behaviour therapy, mindfulness and things like this…Its social problems in a sense which are driving people’s problematic states of mind”, says Roberts.

The psychologist differentiates between a corporate version of a mental health issue and somebody’s individual or social version. “The former”, says Roberts, “individualises people’s problems as personal deficits. So psychiatry would say, ‘the root cause as to why you’re depressed or having hallucinations, is because you’ve got some biochemical defect which is maybe genetically sourced’.

From society to the individual

It therefore, follows, that the remedy to the problem has shifted away from society towards the individual. Dr Roberts notes how this individualistic personal deficit, vulnerability model has played out in terms of the kinds of mental health interventions undertaken within the university system:

“There’s continuous talk of the serious problems that students have on campus. What doesn’t feature in the conversation is the lack of jobs for young people, the fact that they’re heavily in debt, they pay enormous tuition fees, there’s no maintenance grants, mental health services are cut and the families that they’ve come from are on benefits which have been cut for years. Now we’ve seen rises in homelessness, the austerity program the last 10 years, it’s all driving it”, says Roberts.

In other words, says the psychologist, the medical establishment:

“are not really interested in actual personal well-being. They’re interested in maintaining the kind of status quo of where to identify where the problems is. So the focus is on individual problems rather than systemic problems.”

The anxiety economy

It follows that mental health issues cannot be tackled in isolation within the UK or globally without taking in the wider societal context. This, as Dr. Nihara Krause, acknowledges is where what has been termed, ‘the anxiety economy’, fits into the broader picture:

“The anxiety economy is really a term that is coined to look at the rising incidences of anxiety across the board – children, young people and adults – and really trying to think about what is available in the markets to try and deal with that”, says Krause, who adds:

“If you look at the statistics in adults – I think the last survey we had was in 2017 – which said that one in six adults experienced anxiety and anxiety disorder. The latest NHS digital statistics say that perhaps one in eight to one in 12 young people will experience an anxiety disorder.”

Snake oil

However, lack of provision of adequate services to cater for the growth in anxiety disorders has meant that only those who meet a very high threshold will be accepted for treatment. With demand for services outstripping supply, the business opportunities for those who set to profit from the anxiety market also increases. Correspondingly, the growing prevalence of pseudo-science as a justification for maintaining a flawed status-quo is the inevitable fall-out from a mental health system of provision primarily driven by profit. The chief beneficiaries of such a system are snake oil salesman whose financial interests are best served by maintaining a profit-driven anxiety economy that neoliberalism helps perpetuate. 

Dr. Roberts amplifies this latter point: 

“Neoliberalism has created – as it often does – another market and it’s a huge mental well-being market, if you – like mental health market. If you look through the lens of the neoliberal economists he thinks, ‘Well that’s another market.’ Every area of life has now become seen in economic terms. So in a sense it directly leads to commodification of well-being so that we individualize more and more.”

Thus, mental health:

“has to be measured to an individual to become quantified so that it can go up or down. This is about boosting the kinds of artificial ideas associated with the snake oil kind of market. Neoliberalism has become like the air we breathe”, says Roberts, who adds:

“It’s hard to actually get outside, to see it from the outside. We live in a society where we’re under constant surveillance. Mental health is just now one of these areas in which we’ve got to measure it, quantify and self inspect ourselves. Our moods are being policed by ourselves which is a recipe for increasing anxiety which, in effect, is uncertainty and about what’s about to happen next. We’re living in this most cataclysmic uncertain era – it’s not just in the UK because of Brexit and our future relations with Europe and the rest of the world  – but the entire economic system is on the point of collapse. So it’s a massively unpredictable time.”

Perpetual loop

Dr Krause also infers that the wider population are vulnerable to this kind of unpredictability. “The root cause of anxiety”, says Krause, “is fear” which neoliberalism, predicated on profit maximization, helps to perpetuate. “If you have got a fearful group of people trying to find some sort of resource to help themselves feel less fearful, they are going to be attracted to whatever that might be that is marketed so very well these days as helping them”, adds Krause.

In this way, anxiety, fear and neoliberalism are sustained in a perpetual loop.

It’s all very sinister, “and actually quite scary stuff”, due largely, admits Krause, to the pseudo-science aspect predicated, again, on an anxiety industry driven by profit:

“So for example”, says Krause, “sleep has become the most talked about issue of today. Now we’ve found out some very interesting facts about sleep because of our ability to image our brain. However the number of sleep specialists are absolutely huge. The number of gadgets that are available to help you to sleep are enormous. So you have weighted blankets, you have sleep apps, you have a whole range of things. The sleep market or the sort of support for sleep market is between 30 to 40 billion per year. And you have got a very anxious population all wanting to desperately try something.”

The system, says Krause, “is very exploitative of a vulnerable population and I think that’s what we need to be concerned about.”

Teetering on the brink

Irrespective of whether the system is viewed from either a Marxist or neoliberal perspective, the economics profession is having to admit that the economy is teetering on the brink. But the root problems of fear and the fragmentation of communities and services to help the said communities, is a discussion the mainstream have been reluctant to take on board. Krause acknowledges that whilst it’s the case that politicians now talk about economies, neither they, nor the wider population, rarely talk about societies:

“If you go back to the schooling system, a very old but very valuable psychological theory is one of attachment – a core fundamental thing that we need as humans. Because of very large class sizes and our increased competition to do well, that sense of attachment isn’t really possible anymore”, says Krause….So you are growing up in a society where you lack that attachment; people don’t feel safe so they are looking to see where they might form those attachments. That then plays into whatever other systems there might be – whether it’s social media or some other form of connection that they might be able to relate to.”

The lack of connection, to a large extent, explains the growth of gangs which emphasize the importance of group identity. As social beings, humans feel the need to be a part of something in which they feel protected and cherished. Gangs are very good at providing that structure especially if class sizes are so big and there’s an absentee parent figure.

Atomized workplaces

The implications of the societal issues that this lack of connection engenders also encompass anxiety and stress issues related to increasingly atomized workplaces. The NHS is an example of one such environment. The political commentator, Peter Stefanovic, notes in a tweet that “8 in 10 doctors and medical students are at high or very high risk of burnout. “A new report by the British Medical Association reveals junior doctors are most at risk”, he says.

Dr. Krause concurs:

“ I think that junior doctors are under enormous strain. They work very long hours. They don’t have a huge amount of support. They’re dealing with very difficult patients and often they don’t have any ongoing stress management themselves. So I think that is absolutely the case”, says Krause.

Dr Roberts adds some thoughts:

“And this is at a time when the NHS is severely underfunded and under-resourced. In a better situation there would have been much better investments in the NHS for many years, there’d be a larger workforce doing less work… there’d be less of this”, he says.

In order to counteract workplace stress and anxiety, workers have been encouraged by the corporate machine to engage in a simplistic form of mindfulness.

Dr. Krause continues the theme:

“I think our mindfulness is hugely effective but it needs to be used in the right way. And mindfulness in itself is a philosophy, it has to be learned and practiced in the right way. It isn’t about just taking one minute out to do some breathing. And I think that that is sometimes the way that it is marketed.” We need to start to move away from an individualized model of seeing the problem as lying within the individual and really start to think about how it interacts with the system that they are in”, says Krause.

Politically-interactive communities

Dr. Roberts interjected by asserting that the notion of politically-interactive communities addressing the atomizing of neoliberal societies conducive to poor mental health, has proven to be the most successful way of combating it:

“Where those communities – not just in the UK but throughout the world – have organized to combat the kind of corporate forces at bay, mental health is generally very good. The solidarity, mutually beneficial relationships, the sense of personal and collective power and ability to affect change in the world, is good for everybody’s well-being”, says Roberts. 

Achieving this sense of well-being, however, is not helped by a system of education which encourages children to be tested at increasingly young ages intended to fit in with the imperatives associated with neoliberalism – a point reiterated by Roberts:

“There’s this kind of competitive conveyor belt journey through life that misses the point and that’s how you live each moment, to live as best as you can in relation to the environment you’re in and what you have to deal with”, says the psychologist.

Dr. Krause agrees:

“Apart from testing being extremely stressful what it does is it makes children feel that their self-worth is based on their achievements. We have to stop rating ourselves just based on our grades. Children’s education should be all about enjoying the journey rather than the goal which I think is a great model.”

An holistic model for mental health that focuses on living each moment, is totally absent from the conversation. Instead, the emphasis is about addressing problems in an ad-hoc way.

However, according to Dr. Roberts:

“There’s a new society struggling to get through. All the ingredients are there for a more ecologically based society, in which the notion of living well is already enshrined in it to live harmoniously with ourselves, with nature and not to take from nature like we do now. I think the alternative model is almost there just ready to take over if we can just create the right social and economic circumstances and have the will and the courage to see it through.”

Opposing a one size fits all model

Likely to oppose any paradigm shift are the Big Pharma companies and their lobbyists who nevertheless may be persuaded of the benefits of the kind of bio psycho social model proposed by Dr. Krause which attempts to pull together the various strands:

“Whilst we are building a new model, rather than look at the symptoms, we need to get to the cause. We need to start to look at a variety of different ways in which we can support people without using a one size fits all model, as well. But we also need to start to think about what do we offer people who have been waiting, who are really seriously unwell. And how do we actually support them.”

Furthermore, how is this achievable within the context of atomized societies?

Dr Krause stresses the importance of public lobbying to ensure that those affected get the services they need. “It’s never too late”, says the clinical psychologist, who adds that:

“As a community we need to start to think about how we can work collaboratively and create a kind of more cohesive culture, what gets in the way of that and how we might do that.”

Dr. Roberts concurs but also recognizes the importance of getting the balance right between addressing individual need in terms of counselling and psychotherapy, and socially intervening in the form of play spaces, libraries, good quality housing and public spaces for people to interact and feel safe in. “That we nurture these as well as individuals and we put the same effort, if not more, into that. It’s not an exclusive either or”, says Roberts.

Happy workers

Another factor relates to the importance of enlightened bosses nurturing joyous, healthy workplaces which actually improve efficiency, where workers are happy to be.

“That’s the message we have to get through”, says Dr. Krause, who adds:

“In the work with schools at the moment the message is, your child’s grades will improve if they are happy, if they have got better mental health. And it’s the same thing in terms of work is that the efficiency of anyone will improve if they are happy at work, if they have good connections and if they feel that they are looked after.”

For Dr. Roberts, it’s a question of prioritizing well-being above control:

“I think the reason toxic managers can’t see the benefits of what we’ve been discussing is because they are so hell bent on exercising control that the efficiency of their workers doesn’t even become an issue to them”, says Roberts.

Final thoughts

For Dr. Krause, the best way to prevent people from suffering in silence in relation to mental health, is to keep discussing the issues that surround it in different ways within the public domain:

“So first of all start to think a little bit about the fundamental issues like austerity. On the clinical side to be able to provide readily accessible but scientifically based evidence based tools that people can access whether that is digitally or whether that is providing more resources to get a range of different practitioners who might be able to offer support. And to actually really start to look at research and kind of what those outcomes might be”, says Krause.

The last words are with Dr. Roberts:

“There was a slogan I think it was coined by Alice Walker in the middle of the Occupy movement a few years ago. It was, ‘rebellion is the secret of joy’. There is a great deal of truth in that. If we’re not happy with the current system we’ve got to change it for the better in a more human direction.”