They f*** you up

After my hospitalisation for eating disorders, my brother's schizophrenia diagnosis came as a relief, of sorts. Whether family history or chemical imbalance, we desperately seek a reason for the unreasonable.

Getting a mental illness diagnosis can feel like a reprieve. You’re not going mad, or rather, you are, but in a structured, officially acknowledged capacity. If not method, then there is at least legitimacy in your madness. You’re no longer alone in your isolation. You and those around you are no longer uniquely incapable people, failing at life.

I was first hospitalised for anorexia in the late 1980s. Back then it wasn’t seen as an illness, at least not by those who were treating me. I was admitted to a general children’s ward to address the physical symptoms. The not-eating itself was understood to be a moral issue, hence responses to this were strictly punitive, a pattern that continued with later admissions to supposedly more enlightened institutions.

When I found myself in an adolescent mental health unit, I was forced to sign a contract detailing which “privileges” – receiving letters, getting out of bed, being permitted to speak to other residents – I would be granted in line with weight gain. Mentioning food itself was strictly forbidden. Instead, the pressure was on to find some magic key to the past, one that would unlock the mystery of one’s own disruptive actions. Said key was most commonly located in the family home. We all knew this. We all knew that finding monsters under the bed would let each of us off the hook. Until then, as problem children we were obliged to carry the weight of all the pain we’d caused.

Like most people, I didn’t have a perfect childhood. I can sort through the jumble of memories and piece together different patterns, depending on whom I wish to blame for what went wrong, or praise for what went right. Each and every one of us possesses the raw materials for countless neatly structured morality tales. The truth changes from day to day, as joy is rediscovered or trauma relived. Of course, there are some fundamentals, some steps that should never have been taken, some actions beyond the pale. Nevertheless, far more of what goes on requires a particular form of editing, a certain lighting, in order to bestow upon it the necessary meaning.

When my brother was diagnosed with schizophrenia, it felt like a relief, of sorts. Once more family history was tossed in the air, only this time landing in a pattern that said “not anyone’s fault”. This time, it’s the chemicals. The imbalances. Take these words and hold onto them for all you’re worth, for therein lies your salvation. Schizophrenia is the trigger, the root cause. Not human frailty, but science. You can measure it in a test tube, you can even fight it with drugs. No more need for stories. You are officially exonerated by the very life sentence you’ve just been given. Good for you. Then the years drag by and you realise this means nothing.

The question “is mental illness real?” has a self-indulgent, gamey feel. It’s the kind of thing that should be reserved for first-year philosophy students, late at night in someone’s room after too many shots of vodka. Instead it is apparently “medicine’s big new battleground,” psychiatrists versus psychologists in a battle over – what? Professional status or the purity of the human soul? It’s not entirely clear.

As the American Psychiatric Association publishes the fifth edition of the Diagnostic and Statistical Manual (DSM-5), the Division of Clinical Psychology has released the following statement:

Psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias.

Which to me seems fine, as far as statements of the obvious go. It’s not enough to shatter a whole world view. Psychiatry is flawed. Psychiatrists – who are also people – might enumerate symptoms and classify responses but don’t possess some unique insight into the meaninglessness of the human condition. If anything, it’s reassuring to hear this said out loud. After all, if psychiatry was as precise and objective as it’s apparently claimed to be, you’d want to know why human despair still existed at all.

For those suffering from mental illness and their carers, there’s very little to take from this. According to Oliver James – a man who’s ended up basing a whole career on the first line of a Philip Larkin poem – blaming mum and dad for their fuck-ups provides a way forward:

There is a huge body of evidence that our early childhood experiences combined with subsequent exposure to adversity explain a very great deal […] We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity.

Which is all very well, to a degree. Don’t we all want this? As a parent, I want to best meet the needs of my children, regardless of whether mental illness is considered a specific risk to them. After all, is there anyone who believes that the intentional or accidental neglect of children is harmless? We try our best and we could do better. But what of those of us who are already damned? Does the route back lie in unpicking the past? Is there always a route back, or do we just have to plough onwards, making the best of what’s there – whether or not it involves chemical imbalances, and whether or not it’s helped by drugs? When it comes to this, it’s perhaps not so easy to take sides.

I see what the drugs used to treat schizophrenia do to people and it terrifies me. The side-effects are extreme and potentially life-shortening. I imagine books a hundred years from now, documenting our obscene treatment of the mentally ill in the same way that we currently look back on the Victorians, shaking our heads at their unenlightened attitudes towards so-called lunatics. Why did we do that to people?, we will say. Why did we drug them up like that? What were we thinking? The answer is because no one has given us an alternative. No one has yet offered “the truth”. The two options we have – the damning, relationship-destroying blame game versus the slow, drugged-up death sentence – aren’t even options. They overlap. We end up dealing with both at the same time. Take the pills, hate your parents, cling to whatever truths you can get, whatever gets you through the day.

It is easy to create a narrative in which family members deemed to be mentally ill become scapegoats. The victim in the corner takes his Clozaril so no one else has to face up to his or her sins. A neat, quasi-religious reading of what’s really a mess in which everyone’s drowning, measuring out doses and damned if they do, damned if they don’t. The horrific thing about the DCP statement is the degree to which it then fills you with guilt and false hope. You start to wonder whether actually, you’re living in some sci-fi nightmare in which all that’s required to step out into bright sunshine is to stop doling out tablets and inhale the fresh, clean air. And yet you know it doesn’t work like that. You know because you’ve already tried, so you’ve retreated back inside. You know that you’re poisoning yourself and your loved ones. You know that you’re probably living a lie. You watch the decline day by day and yes, the excuses are pathetic and prosaic – but they are real.

We don’t do it because we’re duped, we don’t do it because we’re evil. We haven’t sided with one medical faction over another. We do it because we wake up each morning and there are seconds, minutes and hours to be endured. We make the best of our lives and our guilt-ridden relationships, using the pitiful amounts of knowledge we have. There is still love, and self-awareness, and questioning, but there are also lives to be lived. Until this battle is magically resolved in one blinding flash of truth, what more can any of us do?

Photograph: Getty Images

Glosswitch is a feminist mother of three who works in publishing.

Photo: Bulent Kilic/Getty Images
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We need to talk about the origins of the refugee crisis

Climate change, as much as Isis, is driving Europe's migrant crisis, says Barry Gardiner. 

Leaders get things wrong. Of course they do. They have imperfect information. They face competing political pressures. Ultimately they are human. The mark of a bad leader is not to make the wrong decision. It is to make no decision at all.

David Cameron’s paralysis over the unfolding human tragedy of Syrian refugees should haunt him for the rest of his natural life. At a time when political and moral leadership was most called for he has maintained the most cowardly silence. 

All summer, as Italy, Greece, Hungary and Macedonia have been trying to cope with the largest migration of people this continent has seen in 70 years, Downing Street has kept putting out spokespeople to claim the government is working harder than any other country “to solve the causes of the crisis” and that this justifies the UK’s refusal to take more than the 216 refugees it has so far admitted directly from Syria. The truth is it hasn’t and it doesn’t.

Anyone who truly wants to solve the causes of the nightmare that is Syria today must look beyond the vicious and repressive regime of Assad or the opportunistic barbarism of ISIL. They need to understand why it was that hundreds of thousands of ruined farmers from Al-Hasakeh, Deir Ezzor and AL-Raqqa in the northeast of that country flocked to the cities in search of government assistance in the first place - only to find it did not exist.

Back in 2010 just after David Cameron became Prime Minister, the UN Food and Agriculture Organisation warned that, after the longest and most severe drought in Syria, since records began in 1900, 3 million Syrians were facing extreme poverty. In 2011 the International Institute for Strategic Studies published a report claiming that climate change “will increase the risks of resource shortages, mass migration and civil conflict”. These were some of the deep causes of the Syrian civil war just as they are the deep causes of the conflicts in Tunisia, South Sudan, Somalia, Libya and Egypt. So what about Cameron’s claim that his government has been working to solve them?

Two years after that Institute for Strategic Studies report pointed out that conflict as a result of  drought in countries like Ethiopia, Eritrea and Somalia had already claimed 600,000 lives,  the parliamentary Committee on Arms Export Controls found the UK Government had issued more than 3,000 export licenses for military and intelligence equipment worth a total of £12.3bn to countries which were on its own official list for human rights abuses; including to Libya, Tunisia, Somalia, Sudan, Egypt and Syria. That was the same year that UK aid to Africa was cut by 7.4% to just £3.4billion. Working to solve the root causes? Or working to fuel the ongoing conflict?

A year later in 2014 home office minister, James Brokenshire told the House of Commons that the government would no longer provide support to the Mare Nostrum operation that was estimated to have saved the lives of more than 150,000 refugees in the Mediterranean, because it was providing what the government called a “pull factor”. He said: “The government believes the most effective way to prevent refugees and migrants attempting this dangerous crossing, is to focus our attention on countries of origin and transit, as well as taking steps to fight the people smugglers who wilfully put lives at risk by packing migrants into unseaworthy boats.”

In fact the ending of the rescue operation did not reduce the number of refugees. It was not after all a “pull factor” but the push factor – what was happening in Syria - that proved most important. Earlier this summer, David Cameron indicated that he believed the UK should consider joining the United States in the bombing campaign against Isis in Syria, yet we know that for every refugee fleeing persecution under Assad, or the murderous thuggery of ISIS, there is another fleeing the bombing of their city by the United States in its attempt to degrade ISIS.  The bombing of one’s home is a powerful push factor.

The UK has not even fulfilled Brokenshire’s promise to fight the people smugglers. The Financial Action Task Force has reported that human trafficking generates proportionately fewer Suspicious Activity Reports (SARs) annually than other comparable crimes because the level of awareness is lower. Prosecuting the heads of the trafficking networks has not been a focus of government activity. Scarcely a dozen minor operatives pushing boats on the shores of Turkey have actually been arrested. But it is not the minnows that the UK government should be concentrating on. It is their bosses with a bank account in London where a series of remittances are coming in from money transfer businesses in Turkey or North Africa. Ministers should be putting real pressure on UK banks who should be registering SARs so the authorities can investigate and begin to prosecute the ultimate beneficiaries who are driving and orchestrating this human misery. They are not.

That image, which few of us will ever completely erase from our mind, will no doubt prompt David Cameron to make a renewed gesture. An extra million for refugee camps in Jordan, or perhaps a voluntary commitment to take a couple of thousand more refugees under a new European Quota scheme. But if the UK had been serious about tackling the causes of this crisis it had the opportunity in Addis Ababa in July this year at the Funding for Sustainable Development Conference. In fact it failed to bring forward new money for the very climate adaptation that could stem the flow of refugees. In Paris this December the world will try to reach agreement on combating the dangerous climate change that Syria and North Africa are already experiencing. Without agreement there, we in the rich world will have to get used to our trains being disrupted, our borders controls being breached and many more bodies being washed up on our beaches.