Last weekend, I was part of a panel for the Changing Minds festival at the South Bank Centre, London. The session was titled “What’s in your head?” and was about how developments in neuroscience and medicine have expanded our understanding of mental health issues.
The session was chaired by Dr Paola Dazzan, accomplished psychiatrist and key figure in King’s College “Women in Science Initiative” which aims to tackle some of the barriers that women scientist face in their career progression. The panel consisted of Dr Suzanne O’Sullivan (neurologist and author of the excellent “It’s All In Your Head” about the nature, severity and stigma around psychosomatic illness), Lavinia Greenlaw (award winning poet behind the fascinating sensory-manipulating sound work Audio Obscura), and … me. The guy who faffs about in the Guardian science section. Like most things I end up doing, I suspect this was due to administrative error.
It was an interesting and informative discussion, which lead to an interesting tangent towards the end. Basically, it was argued that many people seem to have the view that a specific condition, ailment or disease will affect everyone in a reliable and predictable manner. If something has a recognised physical basis, then it will have the same effect and cause the same symptoms in everyone who is afflicted with it. However, humans being as complex as they are, this is far from the truth.
What with the constant austerity, NHS becoming a political battleground and constant talk of those “deserving” of disability benefits or similar, it’s depressingly common to see actual humans being reduced to what they cost the health service, or whether they’re sick or desperate enough to warrant actual help. This sort of thinking hinges on there being a clear division between “ill enough” and “not ill enough” that can be measured by an observer.
This notion is, of course, ludicrous.
How badly affected someone is by a health issue depends on how it is perceived by the individual, and there are so many things that can influence this, even if it’s quite an obvious physical issue.
Take pain, the most obvious problem resulting from a physical health issue. How do you measure, objectively, how much pain someone is in? It’s such a common concern that of course there are many scales and methods, but all of these differ and rely largely on the person in pain describing what they’re experiencing. As such, you can get tremendous variation, even if the cause is the same.
The way the nervous system detects pain is baffling enough, resulting in people having different pain thresholds, meaning the amount of pain it takes to be truly debilitating fluctuates from person to person. This can be the result of genetics, development, or even influenced by mental state, hence the existence of pain clinics. A more common demonstration are those many examples of “men experiencing labour pains”, or similar. An amusing and satisfying thing to watch, no doubt, but not really scientifically valid. Pregnant women’s bodies undergo considerable changes while carrying a baby to term, and one of these seems to be an elevated pain threshold during labour.
This isn’t to say the act of giving birth isn’t an incredible ordeal for women, it’s just that strapping electrodes to a man’s nether regions isn’t going to be the same thing. The physical and neuroanatomical systems are wildly different.
Taken together, this does explain a lot, like how you often hear about people with severe or life-threatening conditions being told by doctors that it’s nothing serious, or not even going to the doctors until their symptoms become genuinely debilitating and it’s too late to do anything about them.
Some people, for many different reasons, aren’t as badly affected by recognisable health issues as others. On the plus side, this means they can carry on functioning normally beyond the point where others would be laid low. On the other hand, such people can overlook serious issues, or even have their concerns dismissed or ignored if they’re not visibly “ill enough”, even by medical professionals, who often only have their observations and assumptions to go on. You might think this is unpardonable behaviour, but if you’ve ever mocked someone for having “man flu” then you’ve done it yourself.
This all means that some people can experience health problems in ways that are genuinely debilitating, despite others not considering it something as serious as that.
This can often be doubly true for mental health problems. A physical ailment can be easier to recognise as a problem than a mental one, purely because it has a visible, tangible basis. If someone turns up at the doctors with their leg twisted the wrong way round, or a harpoon sticking out of their shoulder, or coughing up all manner of unpleasant substances, its obvious what the problem is. This does not determine how much the individual is going through or how they will deal with it or what the prognosis is, it just provides something tangible for medical professionals to work on. A broken leg is going to be an obvious problem that needs fixing no matter when it happens.
By contrast, mental health problems and illness are far more slippery issues, and can often be largely the result of social or cultural factors, rather than anything more scientifically consistent. Something that was once widely considered a “mental illness” is now normal human behaviour, mere decades later.
How people develop and experience mental health problems is just as if not more variable than for physical health problem, and defining them is more difficult as a result. There are those who argue that issues like psychosis need a whole new approach with regards to how it’s talked about and recognised, and they make a decent case for this.
There is a vast wealth of data and evidence that impacts upon these issues, like how culture and society affects mental health, or how age affects perception of disease symptoms, or how the mind-body relationship is so complex and intertwined that the mere act of differentiating between mental and physical health is a laughably futile effort.
Yes, you may get malingerers, or hypochondriacs, or others who exaggerate poor health concerns for their own ends. But in the vast majority of cases, the only person who can reliably say how badly an illness is affecting them is the individual themselves. It’s a constant challenge for highly trained medical professionals to get it right, despite their best efforts. It’s ridiculous to think you can do it with an arbitrary assessment, despite what some MPs may believe.
Dean Burnett’s debut book The Idiot Brain is available from February the 18th. @garwboy
- The Idiot Brain by Dean Burnett (Guardian Faber, £12.99). To order a copy for £7.99, go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min. p&p of £1.99.
