Informing the public about 'mental health conditions'

Two recent experiences while conducting therapy with a client troubled by intrusive obsessional thoughts has alerted to me to the care that needs to be taken by charities and other ‘official’ bodies when informing the public about ‘mental health conditions’. My client knows that his thoughts are irrational but he still feels that because he ‘has OCD’ his life will be ruined, his wife will leave him, he is unfit to be a father, etc. He is in an extremely anxious state most of the time and in the care of the local CMHT. Like many clients who are anxious for similar reasons, he seeks reassurance about ‘whether he really has OCD’ and whether his catastrophic thinking is justified.

The current dogma – that ‘mental health conditions’ are likely any other medical condition, that everyone should share their mental health concerns with friends and employers, and that once accurately diagnosed, treatment is available – is a kind of fairyland that neither clients nor their therapists believe in. It ignores the fact that almost every diagnosis is an arbitrary cut-off point along several dimensions of distress/handicap. People seeking information are often unaware of this. They think they either have the illness, disorder, disease, or whatever, or don’t. Moreover, one does not get the impression from the information available that every person is unique. Each person has a different family history, life circumstances, coping style, personality, and is impacted in different ways. There is no suggestion that formulating the varied causes of a problem is a skilled and drawn-out business.

My client’s attempt to obtain reassurance from his GP (over a brief telephone call with a doctor he didn’t know) yielded the response that he was probably suffering from a ‘schizoid psychosis’ and should seek psychiatric help immediately. Even he thought this was ridiculous and was able to dismiss the advice.

Another attempt to seek reassurance was from an OCD charity. I had only seen him a couple of times, and despite my attempt to get him to restrict his web-searching, he followed this one up and read a page on ‘the impact of OCD’. As he reported later, he became seriously suicidal for the rest of the day. Fortunately, he has good support from family and friends and did not act upon his suicidal feelings.

This prompted me to read the information and contact the charity. After all, I have a duty of care to my clients, and if one ends their life (it has happened before) I would be summoned to the inquest and asked to give an account of myself. I could be investigated by regulatory bodies and could be struck off, losing my livelihood, should it be thought that I had not taken appropriate precautions.

In my email to the charity, I pointed out these facts of the matter, and that I would have had to inform the inquest that his suicide (had it taken place) followed his reading of their webpage on the impact of OCD. I pointed out that this might even have had legal implications. I also expressed concern that reassurance-seeking was typical of people with intrusive thoughts and that the content of the ‘Impact’ webpage would only have served to reinforce his fears. I cited some of the information as follows: ‘that it [OCD] has a devastating on their life’, that the WHO has ranked OCD ‘in the top ten of the most disabling illnesses of any kind’, that ’50% of all cases fall into the severe category’, that it is ‘the fifth leading cause of disease burden’, that it can ‘completely ruin’ relationships, career, access to own children, etc., etc.

The response from the chief executive was one of outrage: that my comments were condescending, reprehensible, bizarre, ‘almost threatening’, and not worthy of an accredited CBT therapist. He suggested that my client’s response could have been due to ‘a lack of an adequate therapeutic intervention’ and that the charity would not be altering any of the information on its website. His only concern was ‘accuracy’. This is understandable from a legal standpoint, but the concept of accuracy is contentious in relation to mythology.

On the contrary, he felt that his website offered hope and inspiration. He thought it more important to provide ‘honest information’ and educate visitors to the website that OCD is not just ‘a positive trait and personality quirk’. ‘We can not wrap people in cotton wool’ and we emphasise that OCD ‘was a treatable condition’.

The response I received is demonstration enough that a psychological understanding of so-called mental health has produced almost no dent in the medical model since I qualified as a clinical psychologist in 1966. This is somewhat disheartening although I find that my clients are generally far more enlightened than the organs of information dispensing advice, whether coming from NICE, mental health charities, or some medical services. Apart from the client described above, the question of a diagnosis or a mental illness is almost never mentioned. However, clients are circumspect about how they present themselves to family, friends, and employers, as well they need to be given the prevalence of either/or thinking about ‘mental health problems’, their causes and effects. It’s a pity that a non-medical understanding is so difficult to put across (or is resisted through vested interests).

Richard Hallam