The average GP or psychiatrist even, doesn’t have the time to look much further beyond the physical symptoms. The counsellor however, with the privilege of hearing in depth and in detail the personal history of client, comes to a different conclusion. Medically, there’s nothing wrong with these individuals. But there’s been a lot wrong with the social environment they experience, both as children and as adults. Counsellors often stress this to their clients.
Counsellors and psychotherapists (and, increasingly, psychiatrists) know that the root cause of mental health problems are people. People hurt people. And hurt people hurt people the most. Poor mental health isn’t a medical problem, it’s a social problem brought about by the actions of people – parents, politicians, bosses, companies, friends even. We’re all involved. We all have the potential to pass on psychological stress to the people around us and we all do it from time to time, some much more than others of course. We also vote in local and national politicians who can adopt policies which either reduce stress or increase it.
Why is it important to identify the causes? Perhaps if the paradigm is to direct resources to dealing with symptoms as they emerge, as is currently the case, then it is less important to understand the causes. However, if the aim is to prevent the formation of problems – and also prevent their re-occurence – then it’s crucial to understand the causes.
How the common mental health problems emerge isn’t straightforward and complexity abounds. I’ve found the model proposed by Bentall (1) to chime best with what I and my colleagues observe with adult clients. He essentially proposes that a problem arises from a childhood vulnerability intersecting with an adult life challenge. On its own, the childhood vulnerability may not cause overt problems, because coping mechanisms and a benign adult environment may prevent a psychological crisis from emerging. Furthermore, with a sound childhood, most adults can cope with huge adult challenges without the need for psychological help.
This model nicely explains why one person can cope with, say, losing their job in a confident and positive way, while another responds by falling into a depressive cycle. Self-confidence has a lot to do with self-image, influenced by the subconscious messages the child hears during childhood. Counsellors regularly hear clients reporting their parents telling them as a child: “you’re useless, you’ll never achieve anything”, “I never wanted you in the first place, I should have had an abortion” and many other cruel put-downs. The environment some children grow up in is truly toxic, causing all manner of wounds to the psyche; this results in a false sense of self, problems with emotional development and the emergence of various survival-oriented character types which can cause problems in adult life.
A good way to get a sense of the damage is to look at the range of implicit messages children subconsciously deduce and take on in these harmful environments. Stewart (2), a transactional analysis psychotherapist, refers to 12 “scripts” or messages which structure the developing psyche.
Even this list doesn’t really do justice to the messages which result from childhood trauma, particularly sexual abuse; these include: “I’m shameful”, “I’m bad”, “I can’t trust anyone”, “I can’t trust myself”, “I’m defective”.
It’s the identification and correction of these deeply held beliefs that is the stuff of in-depth counselling and psychotherapy.
So much for the vulnerabilities, what about the life challenges? Well these are more well-known and include losses, trauma and stress of all kinds. But let’s take a look at stress as I think this is more complex and perhaps subtle. At Platform for Life, where we work only among disadvantaged communities, we see at first hand how deprivation brings a toxic mix of environmental stresses. We also see how poverty drives poor mental health and vice versa, resulting in the potential for a vicious cycle of decline.
Poverty is of course more than not having a sufficient income for a basic lifestyle, it’s the sense of being alienated from the rest of society, of being less important, of trying to live without the sustaining force of close trusted friends and relatives, reduced public services, access to nature, spiritual refreshment, a quality diet, opportunities for sport and recreation, opportunities to contribute to society; in short all the things that make life happy and fulfilling. It also means having to cope with a higher level of the bureaucratic stress than that which afflicts all of us from time to time. For those with PTSD-like symptoms or a history of abuse, the prevalence of crime and antisocial behaviour in deprived areas is a constant source of stress, and one that can often limit people’s exposure to the outside world.
Alongside childhood vulnerabilities and adult adversity, I suggest a third requirement for a mental health problem to emerge – the lack of a supportive environment. I’m struck how often clients tell me that their particularly adversity, whether encountered as a child or as an adult, was accompanied by the absence of a trusted and close parent, partner or friend with whom the trauma could be discussed and processed. This is the natural way that trauma can be healed (there’s a lot of neuroscience which explains this process). For example, every adult who’s told me about their childhood abuse (of any kind) says they had no-one to talk it through with at the time. The trauma could only be internalised, causing immediate and long lasting damage.
This third requirement is of particular importance when looking at the mental health of deprived communities; here it seems that trusted, close individuals with whom adversity can be processed are much thinner on the ground. It’s a core reason why counselling – the professional healing environment, if you like – is such a key need, alongside of course other agencies who can provide support.
As a society, we should make every effort to ensure that our children grow up in a healthy and supportive family environment. At a strategic level, it’s as simple as that. At a practical level, it’s more complicated of course, but the experience of Platform for Life, and of those who refer to us, is that good mental health is central and crucial. Without that, other interventions by schools, doctors, social workers and others cannot be fully effective.
Putting mental health at the heart of the strategy, there are two main options;
Just as man passes on misery to man, mankind is also capable of passing wellbeing on to mankind. Counsellors often observe that, as their clients psychologically heal, there’s a ripple effect as something positive gets passed around in the client’s world and relationships improve. Perhaps parents start to get on better with their children, children start to form bonds with peers or relationships in the wider family improve. We see that vicious cycles can flip into virtuous cycles, especially when inner healing coincides with something positive in the environment, such as a welfare appeal being upheld or an exam being passed.