Alice in Mental Healthland: A Journey Through the Mind’s Rabbit Holes…

Alice Descends

It started with Fergal Keane and an “In-Depth” article on the BBC website on a Sunday morning in January. I soon realized this was the entrance to a rabbit-hole, that once I went in, I would fall down and be there for some time. In Fergal’s excellent piece – he cannot write anything else- he opened up about his mental health challenges; a problem with alcohol, PTSD and periods of deep depression that had him in and out of hospital over his busy and successful career. He has now achieved an accommodation with his Mind following his insight that happiness is; ethereal, fleeting and hard won. There is a need to work hard for it, he tells us. He has been doing the work of real happiness for some time now and is achieving it. It’s a journey not a destination. Really loving and caring for others, appreciating the beauty of nature and being kind to yourself is all that is needed; so why so difficult, asks Fergal.

He now writes a gratitude list every morning, reads more poetry, goes for long nature walks and has started to meditate. He goes to the movies, enjoys cleaning, washing, cooking and paying the bills; small quotidian pleasures. He has returned to a simpler life, one more likely to offer the happiness he seeks. Not pleasure but happiness. Happiness is a completely different thing to pleasure. Not so different then to conservative activist Jordan Peterson’s 12 Steps Book; clean your room, stand upright…etc and indeed our very own Public Health Agency’s “Take 5”.

Take 5 Campaign

What Fergal is doing is fully engaging with the “Take 5” messages currently being promoted by the Public Health Agency in the most recent Living Well Pharmacy campaign across N. Ireland. Take 5 tells us that to improve mental-health we need to: connect, exercise, give, take notice and keep learning. The benefits of these five activities can transform our lives, and yet what seems so simple is, as Fergal Keane has found, difficult, requiring hard work over time, and most of us don’t know how to do it or just can’t be bothered.

Hi Phillipa

In a side tunnel of this rabbit-warren – The Sunday Times Magazine – I met psychotherapist Phillipa Perry, wife of artist Grayson Perry. In this interview, Phillipa candidly suggested that many of her clients just needed to wise-up and stop being so self-centred. She is convinced that people are too focused on their own catastrophic thoughts without any reference to facts. They allow terrifying thoughts to occupy their minds so its not surprising they suffer from poor mental health. We need to know which thoughts are unhelpful and toxic and need to be discarded, she insists. This is something GPs neither have time nor training to address when meeting patients seeking help.

Interestingly, the Sunday Times journalist tells us that the day after this interview, and before it was published, Phillipa contacted asking if this comment could be deleted as she feared a woke backlash. It wasn’t deleted and she didn’t get the backlash and the article is much the better for it.

Also, in this edition of the Sunday Times an article reported that 80 percent of UK GPs agreed, in a survey, that everyday stresses and strains are being too readily identified as mental illness. Most patients prescribed antidepressants probably didn’t need them they just needed to change their lives and become more caring and connected. GPs feel powerless to integrate this message into patient advice perhaps because they fear being accused of preaching.

Meet the new authors

The books section of the Times that Sunday featured a number of mental health self-help books and I suppose this should not be considered unusual given society’s need for magic-bullets to make our lives better and improve mental health even though none of these books will ever live-up to the hype on the dust sleeve.

One of the books from a young author TJ Power, his best seller The DOSE Effect, was too tempting to ignore and I was off into another tunnel. The book aimed at Millennials and younger adults makes the case that we need to learn to live our lives so that our brain neurotransmitters are in optimal balance. Dopamine, Oxytocin, Serotonin and Endorphins (DOSE) are the neurotransmitters discussed and while offering a useful explanation this book is too simplistic. I went down this rabbit-hole for all of the following week and got little in return.

A much better book covering the role of brain neurotransmitter in mental health and beyond is The Molecule of More by Daniel Liberman and Michael Long and which off course is about dopamine. Where dopamine focuses on maximising motivation for more of the things we like and for designing our futures, Oxytocin, Serotonin and Endorphins are grouped together as the Here and Now Neurotransmitters (H&Ns). The H&Ns are the neurotransmitters that when active make us appreciate the here and now. In balance with dopamine, they bring happiness. This off course is the purpose of the Talking Therapies; Motivational Interviewing, CBT and Mindfulness getting us to a present focus where we can enjoy and appreciate things better. This is also where Fergal Keane has just arrived with his hard work, maximising his H&N chemicals to counter and calm the wonderous, dangerous dopamine which is off course the core of his talent, creativity and insatiable ambition. Raging dopamine has over his life supressed the H&N neurotransmitters forcing him to succeed, yes, but also to exhaust and depress him and give him a difficult relationship with alcohol and ultimately chronic PTSD. There is tragically no end to the more that dopamine seeks and this is why it makes so many of us so unhappy.

Alice emerges

I knew it would be a long journey as soon as I entered and when I finally emerged about three weeks later rubbing my eyes and feeling Alice-like, I have a much better appreciation of the mistakes we are making in mental health policies and treatments. We fail mainly because current culture demands a diagnose and treat approach. Self-efficacy and resilience building are vital yet not supported. I have been less successful in understanding how we might better address our current mental health crisis. It certainly won’t be done by Mike Nesbitt delivering a speech at the Assembly no matter how passionate he is about this topic. We must start teaching personal resilience at school.

It is difficult to live our lives differently given the western capitalist culture we embrace and in which we are embedded and invested but we really need behaviours to support greater harmony in our key neurotransmitters as Fergal Keane has learned to do and is so much the happier for it.