‘We all experience mental health, and we all struggle’

Awareness of and treatment for mental health issues has improved vastly over the past century. But, says counselling psychologist and broadcast journalist Dr Sian Williams, we still have a way to go

IIntroduced in 1963, Valium was billed as ‘Mother’s Little Helper’, and became one of the most prescribed drugs of all time

n the 1920s, it was bedlam for all those suffering from mental ill health, or who were depressed, grieving, or anxious. Bethlem Hospital, where the name ‘bedlam’ comes from, was one of more than a hundred ‘lunatic asylums’ across England and Wales housing the ‘mentally deficient’. Thousands were forcibly detained there; most didn’t come out. One woman who did was Rachel Godde-smith. Rachel was 48 and became severely depressed after her GP husband died of a drugs overdose (it’s thought he was addicted to morphine, not uncommon among doctors at the time). Her sister signed committal papers for her to be forcibly detained and she fought for 12 years to be released. In 1922, Rachel published Experiences Of An Asylum Patient, in which she described being in a room with 10 others, listening to the wails and shouts of ‘frenzied women’ who were beaten violently or taken to baths and ‘ducked under’.

Her book would raise questions in parliament about how to treat those with mental health issues. Asylums became ‘mental hospitals’, a ‘lunatic’ was ‘a person of unsound mind’, but the stigma remained for decades. I remember kids at my school in the 1970s teasing one another that they’d be sent to the ‘loony bin’. Now, having spent years with those struggling with mental health issues as a counselling psychologist, I’m horrified at the type of language we used, borne out of ignorance and, probably, fear. It’s clear that society didn’t listen, understand or know how best to help. Instead, it marginalised, humiliated and excluded.

CHANGING MINDS

It’s normal to have ‘human frailty’, and expect treatment

Throughout the 1920s, asylums also housed around 12,000 serving and former servicemen with ‘war neurosis’. One journalist described them as ‘mouthing like madmen, figures of dreadful terror, speechless and uncontrollable’.

We now know that this is post-traumatic stress disorder (PTSD). Meanwhile, women who were struggling with mental ill health could be written off as having ‘hysteria’, a word from the Greek meaning ‘womb’. Sigmund Freud, the father of psychoanalysis, believed it resulted from ‘penis envy’ and the psychological scars of sexual trauma or repression.

As controversial as Freud’s views were, he was a pioneer of talking therapy, at a time where treatment for mental health could be blunt and barbaric. One popular ‘cure’ for schizophrenia, depression and bipolar disorder was the prefrontal lobotomy, where holes were drilled into the skull.

Patients who had the procedure were often left immature, lethargic and prone to rage. Electroshock therapy (ECT), zapping currents into the brain, was another way of trying to regulate behaviour and personality.

The misuse and side-effects of these treatments meant they fell out of fashion in the 1950s and the trend for medication took over. In the newly formed NHS, almost half of all beds were taken up by those with mental illness and there were pills for everything; such as lithium for psychosis and benzodiazepines to treat anxiety and insomnia. In 1963, diazepam came on to the market in the form of Valium, a multipurpose drug quickly billed as ‘Mother’s Little Helper’. Many women became dependent on it, and it would go on to become one of the most prescribed drugs of all time. Around this time, the stigma and silence around mental health was gradually breaking down. In 1954, Jack Archer, the pub landlord in The Archers, was admitted to a psychiatric hospital when he spiralled into depression. In 1962, One Flew Over The Cuckoo’s Nest highlighted the risk of lobotomies. Attitudes were slowly evolving, publicly, politically and professionally. The 1959 Mental Health Act had replaced ‘unsound mind’ and ‘mental defectiveness’ with ‘mental disorder’ and, although the focus was still on controlling symptoms rather than trying to understand why someone was struggling, this was being challenged. From Anna Freud, the daughter of Sigmund, who set up a London clinic for traumatised children in 1941, which is still going, to Aaron Beck, who founded

Cognitive Behavioural Therapy (CBT) in the late 1960s to reframe difficult thinking and behaviour, these therapists and thinkers profoundly influenced modern-day helpers, including myself. Those with mental health issues are not weak, or wrong, or deficient; they are us and we are them, all trying our best to make sense of things.

UNDERSTANDING AND COMPASSION

After years of training, I’m now, finally, Dr Williams, and, like the mental health field itself, I’m still developing, learning and questioning. It’s hard to contemplate the fact that, 100 years ago, I might have been diagnosing ‘shell shock’ and prescribing lobotomies. Yet, a century from now, what will psychologists be saying about the way we treat patients? Perhaps they’ll criticise how we still lay the ‘problem’ squarely with the individual, rather than looking at the systems that exacerbate depression, powerlessness and anxiety, such as poverty and poor housing. Or they’ll wonder why people often aren’t able to get the help they need quickly.

Four years ago, I worked with the Duke and Duchess of Cambridge and Prince Harry on their Heads Together campaign. Whether it was Prince Harry talking about the grief of losing his mother, Stephen Fry describing his experiences of bipolar disorder, or Adele speaking about postnatal depression, these discussions are making an impact.

But there is still much to achieve. A century ago, Rachel wanted to clear her name of the ‘undeserved stain of lunacy’ and be seen as ‘perfectly right and normal’, which, of course, she was. It’s normal to have what she called ‘human frailty’, and right to expect treatment if things get too much. But waiting lists for psychological treatment can be huge and mental health does not yet have parity with physical health in either funding or focus. I hope that a century from now it’s accepted that we all have mental health and we can all struggle. We will have stopped locating the ‘problem’ with the individual and think more about how society has contributed and how it can support, not stigmatise. There will be more money, more helpers, more compassion. That will be a real legacy for women like Rachel.