What I wish Stephen Fry understood about mental health

The following letter, addressed to Stephen Fry, is written by Richard Bentall, professor of clinical psychology at the University of Liverpool. It is reproduced here with permission.

Dear Stephen,

You and I attended the same public school (Uppingham, in Rutland) at the same time, in the early 1970s, and our unhappy experiences there have undoubtedly helped to shape our different trajectories, which have led us to a shared interest in mental health.

In your case, your premature departure from Uppingham, and your adventures immediately afterwards, were documented in your wonderful book, Moab is my Washpot. Your subsequent openness about your own mental health difficulties, for which I salute you, has been an inspiration to other mental health sufferers.

In my case, despite a lacklustre academic performance which I attribute mainly to spending much of my adolescence feeling depressed and emotionally abused, I managed to make my way to university and eventually pursued a career in clinical psychology. (My brother, unfortunately, was much worse affected by his time at the school; his expulsion was the start of a long downward spiral that culminated in his suicide, an event that haunts me 20 years later, and which reinforces my determination to improve the public understanding of mental ill-health.)

I have now spent more than 30 years researching severe mental illness, focusing especially on patients with psychosis (who, in conventional psychiatry, are typically diagnosed with ‘bipolar disorder’ or ‘schizophrenia’). It is from this perspective that, reluctantly, I must now ask you to rethink the way that you portray these conditions to the general public. I know that you wish to demystify and destigmatise mental illness, which are surely laudable aims, but my worry is that some aspects of your approach may have the opposite effect from that which you intend.

Conventional psychiatry tends to decontextualise psychiatric disorders, seeing them as discrete brain conditions that are largely genetically determined and barely influenced by the slings and arrows of misfortune, and it was this perspective that was uniquely presented in your recent programme The Not So Secret Life of a Manic Depressive: Ten Years On. According to this ‘brain conditions’ view, psychiatric disorders occur largely out of the blue in individuals who are genetically vulnerable, and the only appropriate response is to find the right medication. Even then, it is usually assumed that severe mental illnesses are lifelong conditions that can only be managed by continuous treatment. However, research into severe mental illness conducted over the last 20 years (not only by me, although I have contributed) tells a more complex story.

To begin with, we now know to a level of certainty that diagnoses such as ‘bipolar disorder’ and ‘schizophrenia’ are not separate conditions [1]. Furthermore, there is no clear line between severe psychiatric disorders and healthy functioning [2], with the consequence that large numbers of people manage to live productive lives despite experiencing symptoms at some time or another, and without seeking help [3]. There is, for example, an international network for people who hear voices, many of whom manage perfectly well without psychiatric care [4]. (In my experience, psychiatrists are often troubled by this ‘fuzziness’ at the edges of mental ill health, which I find puzzling as doctors in physical health have no difficulties with handling arbitrary boundaries; there is no sharp dividing line between healthy and unhealthy blood pressure, for example.)

It also appears that the outcomes for severe mental illness are much more variable than was once thought. Longitudinal research suggests that a surprising number of people manage to make full or partial recoveries [5], even when not taking medication. A complication is that recovery means different things for different people; whereas psychiatrists typically think of recovery in terms of recovery from symptoms, patients more often emphasise the importance of self-esteem, hope for the future, and a valued role in society [6].

Of course genes play a role in making some people more vulnerable to psychiatric disorder than others, but the latest research in molecular genetics challenges simplistic assumptions about ‘schizophrenia’ and ‘bipolar disorder’ being primarily genetic conditions. The genetic risk appears to be shared across a wide range of diagnostic groupings — the same genes are involved when people are diagnosed with schizophrenia, bipolar disorder, ADHD and even, in some cases, autism [7]. More importantly, genetic risk is widely distributed in the population with hundreds, possibly thousands of genes involved, each conferring a tiny increase in risk [8]. Hence (to quote American genetic researcher Kenneth Kendler): ‘The genetic risk for schizophrenia is widely distributed in human populations so that we all carry some degree of risk’ [9].

Of course, some people (possibly yourself) have more of these genes than others, but the fact that so many are involved suggests that it is very unlikely that studying them will lead to therapeutic innovations any time soon. By contrast, consider Huntington’s disease, a terrible degenerative neurological condition that is caused by a single dominant gene with a known biological function. Many years after this gene was discovered there is still no sign of a medical therapy for this simplest of all the genetic conditions.

In your programme, you did not attempt to link your own mental health difficulties to circumstances despite the fact that your story suggested that episodes had been triggered by specific events on at least two occasions (after bravely confronting an extreme homophobe in Uganda, and after extensive jet travel). More importantly, perhaps for understandable reasons, you seemed reluctant to explore any possible connections between your difficulties now and your experiences earlier in life. In fact, recent epidemiological studies have pointed to a wide range of social and environmental factors that increase the risk of mental ill health [10], some of which I am guessing you may be familiar with from personal experience.

These include poverty in childhood [11] and early exposure to urban environments [12]; migration [13] and belonging to an ethnic minority [14] (probably not problems encountered by most public school boys in the early 1970s) but also early separation from parents; childhood sexual, physical and emotional abuse; and bullying in schools [15]. In each of these cases, the evidence of link with future psychiatric disorder is very strong indeed — at least as strong as the genetic evidence. Moreover, there is now good evidence that these kinds of experiences can affect brain structure, explaining the abnormal neuroimaging findings that have been reported for psychiatric patients [16], and that they lead to stress sensitivity and extreme mood fluctuations in adulthood [17]. And of course, there are a myriad of adult adversities that also contribute to mental ill health (debt [18], unhappy marriages [19], excessively demanding work environments [20] and the threat of unemployment [21], to name but a few). Arguably, the biggest cause of human misery is miserable relationships with other people, conducted in miserable circumstances.

Why is all this important? Well, for one thing, many psychiatric patients in Britain feel that services too often ignore their life stories, treating them more like surgical or neurological patients than people whose difficulties have arisen in response to challenging circumstances. In the words of Eleanor Longden, a well-known voice hearer and mental health activist: ‘They almost always ask what is wrong with you and hardly ever ask what happened to you’ [22].

Patients are routinely offered powerful drugs as shown in your programme (I am not saying they don’t have a place) but very rarely the kinds of psychological therapies that may help them to come to terms with these kinds of experiences, or even practical advice (debt counselling probably has a place in the treatment of depression, for example).

Patients’ dissatisfaction with an exclusively medical approach is well founded, because research has shown that this approach has been extraordinarily unsuccessful, despite what clinicians often assert. Whereas survival and recovery rates for severe physical conditions such as cancer and heart disease have improved dramatically since the end of the Second World War [23], recovery rates for severe mental illness have not shifted at all [24]. Even more surprising, you might think, those countries which spend the least on psychiatric services have the best outcomes for severe mental illness [25] whereas those that spend the most have the highest suicide rates [26]. No doubt, if we understood the psychological mechanisms that lead from childhood misfortune to mental illness, we could do more to help people. However, research funding in mental health is being almost exclusively channelled into genetic and neurobiological studies, which have little realistic prospect of yielding practical interventions.

To make matters worse, research shows that exclusively biological theories of mental illness contribute to the stigma experienced by mental health patients, which I know you want to reduce [27]. The more that ordinary people think of mental illness as a genetically determined brain condition, and the less they recognise it to be a reaction to misfortune, the more they shun mental health patients. The biomedical model of mental illness, which your programme showcased, makes it all too easy to believe that humans belong to two sub-species: the mentally well and the mentally ill.

Finally, the biomedical approach entirely neglects the public health dimension of mental illness. Given the evidence from epidemiological studies, we can almost certainly dramatically reduce the prevalence of mental illness in the population by, for example, addressing childhood poverty and inequality, figuring out which aspects of the urban environment are toxic (you might or might not be surprised to know that living close to a park appears to provide some protection against mental illness [28]) and by ensuring that all of our children experience more benign childhoods than the ones we experienced. We cannot do any of these things if we spend all of our time peering into test tubes.

Let my finish by saying, Stephen, that I have the highest respect for you, and I thank you for your efforts to reach out to people who are suffering from mental illness. Please continue with this important work. But please, from now on, do so in a more balanced way.

Sincerely,

Richard Bentall

[1] The literature on this is complex, but includes studies of patients with symptoms along the schizoaffective dimension (e.g. Tamminga, C.A., Pearlson, G., Keshavan, M., Sweeney, J., Clementz, B., & Thaker, G. (2014). Bipolar and Schizophrenia Network for Intermediate Phenotypes: Outcomes across the psychosis continuum. Schizophrenia Bulletin, 40 suppl 2, S131-S137. doi:10.1093/schbul/sbt179); statistical studies of symptom variation (e.g. Reininghaus, U., Priebe, S., & Bentall, R.P. (2013). Testing the psychopathology of psychosis: Evidence for a general psychosis dimension. Schizophrenia Bulletin, 39, 884-895) and studies showing shared genetic contributions to apparently different psychiatric disorders (e.g. Lichtenstein, P., Yip, B.H., Bjork, C., Pawitan, Y., Cannon, T.D., Sullivan, P.F., & Hultman, C.M. (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet, 373, 234-239).

[2] Again, the literature on this is complex, but includes psychological studies of people with psychosis-prone personality traits (Raine, A. (2006). Schizotypal personality: Neurodevelopmental and psychological trajectories. Annual Review of Clinical Psychology, 2, 291-326), including sub-clinical bipolar traits (e.g. Bentall, R.P, Myin-Germeys, I., Smith, A., Knowles, R., Jones, S.H., Smith, T., & Tai, S. (2011). Hypomanic personality, stability of self-esteem and response styles to negative mood. Clinical Psychology and Psychotherapy, 18, 397-410) and also ‘psychometric’ studies which use complex statistical methods (‘taxometrics’) to discover whether there are any natural breaks in the continuum between healthy functioning and psychiatric disorder (e.g. Haslam, N., Holland, E., & Kuppens, P. (2012). Categories versus dimensions in personality and psychopathology: A quantitative review of taxometric research. Psychological Medicine, 42, 903-920).

[3] There are many epidemiological studies which show a surprisingly high prevalence of psychotic-like experiences in the general population. See, for example, Johns, L.C., & van Os, J. (2001). The continuity of psychotic experiences in the general populations. Clinical Psychology Review, 21, 1125-1141. This phenomenon has been demonstrated in respect to bipolar symptoms; see for example, Merikangas, K.R., Akiskal, H.S., Angst, J., Greenberg, P.E., Hirschfield, R.M.A., Petukhova, M. and Kessler, R.C. (2007) Lifetime and 12-Month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry, 64, 543-552

[4] http://www.intervoiceonline.org/

[5] See, for example, Harding, C.M., Brooks, G.W., Ashikage, T., & Strauss, J.S. (1987). The Vermont longitudinal study of persons with severe mental illness: II. Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144, 727-735, and Harrow, M., & Jobe, T.H. (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: A 15-year multifollow-up study. Journal of Nervous and Mental Disease, 195, 406-414.

[6] Morrison, A. P., Shryane, N., Beck, R., Heffernan, S., Law, H., McCusker, R., & Bentall, R.P. (2013). Psychosocial and neuropsychiatric predictors of subjective recovery from psychosis. Psychiatry Research, 208, 203–209.

[7] Psychiatric Genomics Consortium. (2013). Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nature Genetics, 984-994. Note that this finding, from analyzing DNA, is completely consistent with the results of population genetic studies such as Lichtenstein et al. (2009) ibid.

[8] The International Schizophrenia Consortium. (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature, 460, 748-752.

[9] Kendler, K.S. (2014). A joint history of the nature of genetic variation and the nature of schizophrenia. Molecular Psychiatry. doi:10.1038/mp.2014.94

[10] For a recent review, see Bentall, R.P., de Sousa, P., Varese, F., Wickham, S., Sitko, K., Haarmans, M., & Read, J. (2015). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology, 49, 1011-1022.

[11] See, for example, Wicks, S., Hjern, A., & Daman, C. (2010). Social risk or genetic liability for psychosis? A study of children born in Sweden and reared by adoptive parents. American Journal of Psychiatry, 167, 1240-1246.

[12] Vassos, E., Pedersen, C.B., Murray, R.M., Collier, D.A., & Lewis, C.M. (2012). Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin, 38, 1118-1123.

[13] Cantor-Graee, E., & Selten, J.P. (2005). Schizophrenia and migration: A meta-analysis and review. American Journal of Psychiatry, 163, 478-487.

[14] Veling, W., Susser, E., van Os, J., Mackenbach, J.P., Selten, J.P., & Hoek, H.W. (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry, 165, 66-73.

[15] For a meta-analytic summary of the effects of childhood adversity (separation from parents, bullying, childhood abuse) see Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W, Read, J, van Os, J. and Bentall, R.P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661-671. doi:10.1093/schbul/sbs050

[16] Sheffield, J.M., Williams, L.F., Woodward, N.D., & Heckers, S. (2013). Reduced gray matter volume in psychotic disorder patients with a history of childhood sexual abuse. Schizophrenia Research, 143, 185-191.

[17] Glaser, J.P., Van Os, J, Portegijs, P.J., & Myin-Germey, I. (2006). Childhood trauma and emotional reactivity to daily life stress in adult frequent attenders of general practitioners. Journal of Psychosomatic Research, 61, 229-236.

[18] Meltzer, H., Bebbington, P., Brugha, T., Farrell, M., & Jenkins, R. (2013). The relationship between personal debt and specific common mental disorders. European Journal of Public Health, 23, 108-113.

[19] Wade, T.J., & Pevalin, D.J. (2006). Marital transitions and mental health. Journal of Health and Social Behavior, 45, 155-170.

[20] Stansfeld, S. & Candy, B. (2006). Psychosocial work environment and mental health: A meta-analytic review. Scandinavian Journal of Work, Environment & Health, 32, 443-462.

[21] Barr, B., Taylor-Robinson, D., Scott-Samuel, A., & McKee, M. Suicides associated with the 2008-10 economic recession in England: Time trend analysis. British Medical Journal, 345, e5142. doi:10.1136/bmj.e5142

[22] https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

[23] See Chapter 1 of my book Doctoring the mind: Why psychiatric treatments fail (Penguin, 2009) for evidence on historical recovery rates for cancer and heart disease.

[24] This was first pointed out by Richard Warner (1985) in his book Recovery from schizophrenia: Psychiatry and political economy. New York: Routledge & Kegan Paul. For a recent meta-analysis of the historical data, see Jääskeläinen, E., Juola, P., Hirvonen, N., McGrath, J.J., Saha, S., Isohanni, M., & Miettunen, J. (2013). A systematic review and meta-analysis of recovery in schizophrenia. Schizophrenia Bulletin, 39, 1296-1306. doi:10.1093/schbul/sbs130

[25] Sartorius, N., Jablensky, A., Ernberg, G., Leff, J., Korten, A., & Gulibant, W. (1987). Course of schizophrenia in different countries: Some results of a WHO comparative 5-year follow-up study. In H. Hafner, W.G. Gattaz, & W. Janzarik (Eds.), Search for the causes of schizophrenia (Vol. 16, pp. 909-928). Berlin: Springer. See, for more recent data, Saha, S., Chant, D., Welham, J., & McGrath, J.A. (2007). A systematic review of the prevalence of schizophrenia. PLoS Medicine, 2. e141.

[26] See, for example, Shah, A., Bhandarkar, R., & Bhatia, G. (2010). The relationship between general population suicide rates and mental health funding, service provision and national policy: A cross-national study. International Journal of Social Psychiatry, 56, 448-453; and also Rajkumar, A.P., Brinda, E.M., Duba, A.S., Thangadurai, P., & Jacob, K.S. (2013). National suicide rates and mental health system indicators: An eological study of 191 countries. International Journal of Law and Psychiatry, 36, 339-342.

[27] See Read, J., Haslam, N., Sayce, L., & Davies, E. (2006). Prejudice and schizophrenia: A review of the ‘mental illness is an illness like any other’ approach. Acta Psychiatrica Scandinavica, 114, 303-318, and Angermeyer, M.C., Holzinger, A., Carta, M.G., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. British Journal of Psychiatry, 199, 367-372.

[28] van den Berg, A.E., Maas, J., Verheij, R.A., & Groenewegen, P.P. (2010). Green space as a buffer between stressful life events and health. Social Science and Medicine, 70, 1203-1210.


  • Ron Todd

    Mr Fry has been on the telly; he is part of the establishment; belongs to one of the governments favoured minority groups He must know more than all the experts.

  • Yan

    Saw him on Jonathan Ross whereby he was asked if where to have kids with his teenage male so called ‘husband’ – quite sickening really all his perversion

    • Your bigotry is really quite ugly. You might want to address that.

  • HaroldAMaio

    —-the stigma experienced by mental health patients

    “Belief in stigma” is what you intend, unless you are proffering that prejudice.

    Yes, belief in that prejudice can control lives.

    • Marcel

      Yes, but the prejudice against those with depression or any other metal condition is widespread in societies, including the workplace where employers are unlikely to hire anyone so-diagnosed openly disclosing a mental illness, unless they are either famous or otherwise extraordinary.

      Twenty years ago, following an evaluation of his chronic depression by a panel of psychologists, a dear and intelligent friend of mine in Canada was informed that he should avoid any attempt to form a romantic relationship with a woman again, regardless of the fact that he has never been violent of abusive to women, and has no addictions to illicit drugs or to alcohol. Now in his early sixties, he remains single, continues to take his medication, and the only thing he looks forward to is death.

      Aghast by the evaluation, his personal physician at the time insisted that he seek re-evaluation by a psychiatrist. After taking his history, the psychiatrist concluded that the depression was circumstantial and largely due to a lack of employment. He explained that, in his clinical experience, circumstantial depression among those with chronic unemployement was very common and could only be remedied by gainful, long-term employment, or by means of gainful self-employment.

      For 10 years, he was self-employed in a successful career and managed very well without medication. Since the crash of 2008, however, his life has been a struggle. The woman he fell in love with left him when he became broke; he resumed antidepressant medication; and he subsists in poverty without substantial relief of symptoms.

      An evaluation by one of the countries top psychiatrists recently concluded that in his case, talk therapy would be useless and that his condition was incurable. My friend believes that if his financial circumstances changed for the better, his depression would lift, as it did before.

  • Bob339

    I just wish Frey would disappear from our screens. He cannot act, he is a poor imitation of Wogan, (who was a poor imitation of P.G. Wodehouse), and he is depressingly ugly.

    • lanceken

      Why would you call him “depressingly ugly”? What a twattish thing to say. I don’t go in for the national treasure crap, and he’s clearly not musical enough to present documentaries on Wagner–but that’s got nothing to do with his (perfectly normal) appearance.

      • Bob339

        Please just die. You vulgar toad.

    • Rajpdxusa

      What an utterly repulsive comment.

      Is that what you were going for?

      • Miss Floribunda Rose

        It’s only a word…….

    • Omnishambles

      Cunt!

      • Miss Floribunda Rose

        I wasn’t aware that cunt was allowed. I normally spell it with a K so as to avoid moderation.

      • Carol-Anne

        Completely unnecessary to take this discussion in any abusive or take any ‘side on the generic/medication/ nature/nurture, science versus humanities divides. These are unhelpful and add little illumination.There are political levers at play in all research debates, and knowledge Sharing is no different. Oppositional binaries are not conducive of discussion or nuance. Thought theoretically at least all researchers had left behind this bifurcation years ago. Every voice speaking to break mental illness stigma is welcome, celebrity or not. Please could researchers from both sides of the disciplinary divide see that lived experience is valuable data although drawing conclusions very difficult as the individual situations do not allow for easy cross-tabulation.

        • Omnishambles

          Excuse me but Bob339 is entitled to have his disgusting opinion on Stephen Fry in the same way that I am allowed to have my disgusting opinion that he (Bob) is indeed, a cunt.

      • Captain Sarcasm

        You’re such a little internet tough guy. Based on your posts, clearly a gamer man-child still living with his mom.

        • Omnishambles

          Have you been following me about on the internet? That’s a bit odd, I don’t know you. You are right about the gamer and man-child, however I do not live at home with my parents. Internet tough guy? I don’t think so. That’s a bit rich from coming a dude named “Captain Sarcasm”.

          • Captain Sarcasm

            Nope. Before tonight, you had set your Disqus account to show all your comments. Following you on the internet, in order to see what a silly little childish troll you are, was unnecessary. All it took was one itsy bitsy click. Hardly any effort at all.

            I can see that, out of the absolute humiliation that comes with having what you call a life highlighted, you have changed those settings. Which is completely understandable. But, nah bruh, it didn’t take much effort to figure you out.

            I hope that answers your question, and glad I could make a difference in the world!

          • Omnishambles

            You seem to care a lot about what I say and do and like to write full paragraphs in response to me. You are the true troll trying to get kicks out of the realisation I lead a “pathetic existence”. Also, The guy I called a cunt was bashing on Stephen Fry for being homosexual. Like I said: That guy is allowed to have his horrific homophobic opinion in the same way I’m allowed to have my horrific opinion that he is a cunt. You think you are so clever but the truth is your just like the rest of ’em.

            ; )

          • Captain Sarcasm

            Would you hurry up and get the last word, so that I don’t have to listen to your whiny, cloying moralizing every ten days or so? Pls and thank you.

          • Omnishambles

            We could talk about something we share an interest in other than needlessly attacking each other.

  • sarah

    Interesting article. I think Prof Bentall and Stephen Fry are at opposing ends of the spectrum which attempts to explain mental illness and distress. Neither are right or wrong, but to focus exclusively on one side of either of the spectrum is unhelpful. ‘There are two sides to every story and the truth usually lies in the middle.’

    • Michael H Kenyon

      One knows a lot more about mental health and the complexity of the conditions (Bentall, smartypants). But I wish his pal Oliver “Old Etonian” James would internalise the references here, which are far more nuanced than OJ’s almost 100% environment and social constructionist position. As for celebrity insights into mental disorder – the myth of personal validation is in operation, and celebs are none the wiser than the rest of us, though often more fickle to fads.

    • Maureen Fisher

      The reason why the “environmental” position was largely abandoned was because of the toxic legacy of R.D.Laing blaming the “schizoid mother” for all mental illness. I’m surprised he hasn’t laid into those nasty mothers.

      • Marian B. Goldstein

        While it is correct that Laing understood that so-called “schizophrenia”, as well as other so-called “mental illness”, is a reaction to life circumstances, rather than a biological brain disease, neither he nor anybody else ever blamed any “schizoid” mothers. It was Theodore Lidz who coined the term “schizophrenogenic (!) mother”. Please get your facts straight.

    • JC

      In this case the truth does not lie in the middle though. Psychiatric drugs are harmful.

      • sarah

        I think polemic views like yours are harmful. Do you base your opinions on the experience of many? Psychotropic drugs are not the answer for everyone but some people find them incredibly helpful.

        • JC

          I base my experience on psychiatrist Peter Breggin’s books and podcast.

          • sarah

            Well that says it all. I am saddened and surprised that someone would make such a strong statement on the basis of one persons work.Perhaps reading more widely would give you a more balanced, educated view.

          • JC

            I used to think psychiatric drugs were good however I’ve been reading a lot about how they are not precise and just interfere with brain function. Just think about this, the doctors prescribing them do no tests at all, then prescribe drugs. There is no test available that indicates anything about the brain. Anyway I can’t go into it all here. Plus, I read a lot and widely! I love to read. That’s why I’m here reading this article!!! Should you smoke cigarettes or not? Maybe the truth lies in the middle and have a few a day.

  • Zanderz

    As Morrissey said (he of the Smiths fame and sufferer of depression) ‘Depression is almost always circumstantial.’ My own experience would back that up.

  • charlesx

    Oh dear, another left-wing academic (check his tweets) attempts to downplay the role of genetics and upgrade the role of social and societal factors. And of course he can cite other like-minded academics, so it must be true.

    As someone who has suffered from (mild) depression, as did a parent, and who, like Stephen Fry, did not suffer from childhood poverty etc, my experience is much as Fry portrayed it. These things just bubble up, unpredictably, and usually have nothing to do with childhood upbringing or events, contrary to the trendy leftist view.

    Fry’s programme was excellent. If you haven’t seen it yet, find it on iplayer at the link given in the piece.

    • Yes. Your anecdotal “evidence” trumps empirical psychological research. It’s not like all mainstream psychologists share Bentall’s balanced view of a nature-nurture mix when it comes to the aetiology of mental illness or anything…

      • Rajpdxusa

        Actually he has a good point – aside from his bizarre and irrelevant assertion about the effect of politics on facts – we should rely more on anecdotal evidence rather than empirical research. I think it would make the world a far more interesting and exciting place….

        We could use it in medicine – like people used to, it would be great for establishing safety standards in cars for example. It could transform the chemical industry and firefighting. Food safety standards. All sorts of areas really.

        I think you should remove your disrespectful post immediately. I had a friend who wrote a disrespectful comment once. He got cooties. You don’t want that!

  • Frederick Bee

    I have at various times in life suffered from what doctors described as “major depression, severe and recurrent.” In each case, medication failed to provide any help at all; the depression finally dissolved when my circumstances changed.

    • Marcel

      You are not alone in that. I have seen the term circumstantial depression applied in such cases, but doubt that it receives official recognition. Perhaps an expert can weigh in on this.

      • Ingridjo

        if in response to difficult circumstances a person becomes sad, this is a healthy reaction an should’t be a newly invented & “diagnosed” condition called “circumstantial depression.” It may make my co-professionals in mental health feel more expert and cushioned against their own natural compassionate response to a fellow human being, but in my opinion it serves no useful purpose for the individual experiencing the sadness.

    • I help people to recover from chronic anxiety. Which I have found always relates to a lack of self worth and have helped hundreds of people recover from it in with just a few hours of finding and “fixing” how they think and feel about the initial cause and core of the problem. Although I believe that depression works in the same way (an initial traumatic event, that set’s up an automated protective system) and can help people in the same way, it is a far more stubborn program and it is backed up by many years of rehearsal of being depressed. I don’t know the answer but am working on it. I do feel that my clients suffering from depression need a lot more follow up help and support and might even benefit from pre-session guidance in helping them gain control of their automated negative thoughts. An open mind on this and honest debate is required.

  • jeremy Morfey

    I don’t think it is an either/or here. Both environment and genetics can influence mental health, and each in unique ways. Treatments too can be medical to correct endemic abnormalities, or they can equally be environmental, improving the prospects of the patient in order to induce a sense of well-being, or at least remove destructive biochemical impulses creating mayhem with one’s health.

    A lot of the environmental may be a normal response, which if allowed to persist, causes illness, and even corrections that make this chronic and more difficult to treat, especially if they occur during hormonal changes, but are only treated in adulthood, when there is less flexibility and capacity to adjust. I have been on a maintenance dose of an antidepressant since 1998 – it makes the difference between getting through the night, or being in a constant state of fatigue. I know I must stay on them for as long as I am without a job (which is unlikely now I am 60 and at last mercifully released from that stigma that condemns the middle-aged) and live alone, since no woman I might like to live with me could love a man who was not worthy of her. It is a constant state of limbo which I suppose the grave will sort out in the end.

    I do think that we have taken a happy social environment shamelessly for granted, and certainly during my lifetime. During the 1960s, whole streets were deemed substandard, demolished in the name of “progress” and the residents parcelled off into sink estates, where there was not the same social cohesion or support. This must have caused damage. From the 1970s, feminism set about demolishing the traditional family in much the same way and for much the same reason (“progress”) with similar repercussions on mental health. The Disclosure & Barring programme in response to the Soham murders has separated children from benign adult culture, with the result that they emerge in their teens unable to deal with the adult world, and woefully ill-prepared. Even marriage has now lost its meaning, now it has, by law, become a temporary arrangement between two like people, rather than a life-long bonding between opposites, where compromises have constantly to be made to sustain it. Finally, the idea that one can have secure employment, and a place in the community, is now a distant dream, and most people perch between making-do and being of no use to anyone (which is grounds for divorce and sanction by the authorities).

    In the past, the churches provided a service whereby a sense of secure well-being could be fostered, leading to the sort of corrections in one’s mental chemistry that lead to good health. Maybe even the progressive in us should be revisiting this? Old Conservatives of my youth might also have pointed to national service, which gave a structure and a self-discipline that was primarily there to safeguard morale. There is no worse enemy to the soldier than poor morale, since it is a slippery foe hard to take aim at, or want to.

  • Maureen Fisher

    Not once does he mention the link between cannabis induced psychosis and schizophrenia which is on the rise.

    • chesters

      absolutely, Maureen: I have worked in medium secure units for mentally disordered offenders, the vast majority of whom had one thing in common (and it certainly wasn’t a ‘bad childhood’) : massive drug use, usually starting with cannabis, from early adolescence. Their index offences – often involving serious violence – were usually committed whilst under the influence.

      • Maureen Fisher

        I’ve seen the same from personal experience.

        • Greg Simmons

          But that says nothing about causality.

      • Mikki

        But why do they start the drug use in the first place?

    • Petros Diveris

      The link is the same as the one between the number of prisons and crime. It’s not causal. You get more crime when you build more prisons, not the other way round. People on a high tend to smoke lots of cigarettes for example, that doesn’t mean that fags cause psychosis. It’s the other way round.

  • chesters

    I think Richard Bentall over-states his case. I have over 30 years’ experience working in mental health, and have rarely met a psychiatrist who ‘decontextualises psychiatric disorders’. This is a caricature. Nor have I found it to be the case that mainstream psychiatrists take the view that recovery is impossible.

    • Roddy McKenzie

      Curious, I have over 30 years of experience in mental health also and he paints it exactly as it is – in my (humble) experience. But isn’t that his point – look up and look about and stop being so invested in our own experience?

      • chesters

        not sure about ‘being so invested in our own experience’. I regard myself as sufficiently open minded. But I read one of Mr Bentall’s previous books, and other pieces, I find his message, still, somewhat ‘anti-psychiatry’. Psychiatrists do not spend all their time ‘peering into test tubes’ – that image is ludicrous.

        • Roddy McKenzie

          You’ve moved on to a different point – but in essence there is nothing wrong with taking a different perspective, I don’t read it as anti-psychiatry simply because it differs from the dominant discourse. I think it is ludicrous to suggest that he is suggesting that psychiatrists spend their time peering into test tubes. He has critiqued the core message of Fry’s programme (which I thought was a fine programme) and responded with some well articulated arguments of his own. Engage with that – don’t simply say that it doesn’t fit your experience (which is only ever precisely that – ‘your’ experience) and dismiss his work by saying it’s anti-psychiatry as if that is some kind of top trump. There are arguments to be made and shutting them down does nobody any favours – especially as Bentall is trying to open it up.

  • Miss Floribunda Rose

    I suspect that Mr Fry reads every article in any publication which concerns himself, though he would probably prefer not to. This is a recipe for distress and mental torture. Hi, Mr Fry! It is time to forget yourself. This is the only solution.

  • Nick_Tamair

    ‘mental health sufferers’?

  • xtian

    My mental health problem is anxiety and after years and years of trying to avoid medication and using therapy I finally have got relief from drugs.

  • Ingridjo

    What a refreshing letter, eloquently written. Recent understandings in the field of epigenetics, expounded brilliantly by Bruce Lipton in the USA, and Nobel nominated Professor Marilyn Monk here at UCL in London demonstrate clearly that we are not slaves to our genes; that the double helix that contains them simply offers us a blueprint and at the deepest level of our existence we make the decisions which genes to lock and which to energise.
    In our emotional lives, the quality of our connections determines how much or how little our need for value, recognition, and love are met, as shown in research findings indicating that married men live longer, healthier lives than bachelors and that also applies to people with a strong sense of spirituality.
    To reduce people to be hapless victims of their genes is not only wrong in my opinion but deskills them and encourages them to give away their intelligence and personal power in the service of their recovery to and maintenance of their personal wellbeing.
    I graduated in psychology in 1972, and in all these years of successful therapeutic outcomes I have never had the need to refer a client to a psychiatrist for medication. I regard my clients as experts in their own lives, using my expertise to steer conversations in ways that empower them and enable them to take decisions based on their own expertise. In this way they assume their own responsibility to work towards an outcome in which to find peace of mind, whatever genes they might have lurking in their DNA.

  • Carol-Anne

    Thank you for this balanced piece. I fear that those supporting an either/or personal position within read into it what they seek. I however, have bipolar and anxiety ( lifetime prevalence) most likely with roots in early developmental experiences, particularly introversion,feelings of difference, school non-acceptance, bullying, ridicule,followed as I became an adult by sexual and verbal assault, domestic violence, unemployment, poverty and decidely poor interpersonal close relationships.

    Undoubtedly all these things have played their part in my wellness, illness even at the most basic level of brain development, neutron pathway changes, and onset of diagnosable cyclothymic episodes of illness.

    It is here I beg not have people dismiss pharmacological interventions completely. When I was diagnosed at 33 perhaps most of the ‘damage’ had been done but my depressions became a mixture of reactive ( circumstancially induced) and cyclothymic clinical depression.

    In my experience it is the reason psychiatric therapy takes years to come close to unpacking this history and etiology of our illnesses. This is often what pulls people away from treatment, even recognising the need for medications, constantly or temporarily.

    Each patient’s experience of their illnesses unique, their readiness to face head on underlying painful memories and willingness to work hard to change what have seemed to be remedies or emotional ‘screening’ is probably where research needs to go. However, having tried to complete a PhD whilst suffering bouts of mania and depression, I have learned that Research Funding is heavily weighted towards Science-based projects, due to perceived University brand enhancement through patent dollars from pharmaceutical multinational companies, and prestigious awards such as Nobels in Chemistry and Medicine as key performance research indicators in Higher Education.

    The inter-disciplinary and highly qualitative research you speak of as our priority to understand mental illness to move beyond rising suicide mortality rates is the only way forward. But how can the mental wellness advocates argue this strongly enough to bureaucrats when both scientists, practioners, patients, and support workers argue from either or perspectives?

    For every Stephen Fry who has the guts to speak candidly, and acknowledge his ‘economic capacity’ to insulate himself from the extremes of his illness, there are ‘holistic and alternative’ therapy self appointed gurus era,I got that all pharmaceutical. Interventionis bad.

    My meds, save my life regularly, but not on ther own. I have a dietician, General Practitioner aware of and in consultation with my Psychiatrist, a psychologist to deal with the basic CBT and self-esteem fluctuations. I also recognise my own triggers, patterns of mood change, and interventions I can adopt to stave off the worst excesses of my illness. Yep, diet, exercise, yoga, meditation, paying added attention to circadian rhythms and sleep habits.

    It has only been since reading the brave and open discussions by Professor Kay Redfield Jamieson, Stephen Fry and Terri Cheney. That I have been able to accept that I am not a ‘broken flawed brain’ inside a hostile body.

    I fear that many of the issues you raise need to be addressed globally, as there appear distinct cultural differences. For example does surviving on unemployment benefits bring less stress within a wealthy first works nation, than those living in complete poverty and degradation in third world nations? And what of Bhutan’s Happiness Index as measure of national pride?

    How do we progress finding answers when there are as you suggest so many variables? Is it possible to quantify how many lives have been saved by ‘celebrities’ candidly owning publicly ven flawed diagnoses?

    Worst of all, apart from voluntary support organisations where those of us with experience of mental illness have forums to speak, how can the two conversations be united across the academic and disciplinary divides? By speaking out about my own mental illness I have taken a stand to be proactive and a mental wellness advocate, yet I am now for all intents and purposes unemployable due to stigma and institutional systemic discrimination.

    I ask you Professor is,how far have we travelled breaking stigma even after such atte,pts to do so by Stephen Fry?

  • Honor Kennedy

    IF Stephen does not want to talk and subsequently talk and link the trauma in his life and make public that Trauma that’s entirely up to him. I would suggest he knows very well the link, and has a very good grip on his illness. That is his message, that he can function and make a positive contribution to any community-environment in which he lives or passes through. I would say That is a pretty powerful message and is what every parent should strive to do for their children with or withought any ilness Mental or otherwise.

  • The medical profession diagnose depression as being caused by a chemical imbalance. When diagnosed the question should be what causes the chemical imbalance – not “here is in tablet form a chemical you are missing” (not a cure just alleviation of the symptom). Our thoughts control our chemical production and it is there that the work needs to be done. A traumatic start in life causes low self worth and that perception continues that. Then what is noticed fits in with that negative self view and belief (cognitive dissonance ensures they don’t notice or absorb the positive). This negative program that runs automatically is the cause of of most depression. This also explains why youngster who took drugs have severe problems. Although the drugs add to the problem, their lack of self worth most likely led to the drug use in the first place. Cause and effect often get confused. Working with the depressed is difficult because the main element to get better, the person’s own self drive and motivation towards wellness, is severely depleted by long term depression and they often don’t feel worthy of recovery. It’s a terrible illness and Stephen is to be applauded for his openness as should Richard be for continuing to debate this.

  • Petros Diveris

    Very informative, many thanks.

  • Paul LJ Catlow

    That’s interesting. The paragraphs outlining the social and environmental factors which can make mental illness more likely – well, I can see a consequence here which impacts on treatment of mental health. our medical schools and our universities in general are now pretty much self-selecting for people from good middle and upper class backgrounds. to Qualify as a doctor is rigorous, calling for five years of dedicated study and the ability to finiancially support yourself adequately during those five years. It makes it more rather than less likely that medical students will be socially fortunate people who come from supportive, fairly affluent, stable, middle-class homes in areas where all those listed social and economic factors are not really considerations. Therefore these are at most only theoretical constructs in the minds of our nexct generation of medfical professionals – if they are considered at all. So there’s straightaway a massive gulf of actual life experience separating doctors from the majority of the people they will be ministering to. And it#s ben demonstrating that the “soft skills” of the medical profession are pretty much lamentable – how much time in medical school is spent on teaching a good “bedside manner”, in teaching a doctor how to listen to the patient, et c?

  • halfbeing

    I find that having a biological explanation for my inability to cope with many situations that most others would find unremarkable is far preferable to seeing it as a moral failing. That said, I agree with Richard Bentall that the contribution of environmental factors must not be underestimated. I know I have a genetic disposition to bipolar disorder because it runs very obviously in my family, but would my depressive and hypomanic episodes be so anxious in character, and therefore possibly that bit more debilitating, if I had not had the childhood I experienced? I suspect not.

  • Myca Palmer

    All opinions are as unique as each of us on the planet, and any words ever written or spoken are just a snapshot moment of views and feelings; not even a page in the book of an individuals life story. For twelve years I had a bipolar label, in a psychiatric hospital thirteen times within that period, six stone heavier than now, on various cocktails of prescribed drugs, experiencing ECT (electric shock treatment), and undergoing different types of therapy. Three years ago I had an experience that transformed my life, so much so that within eight months I had lost the six stone in weight, come off all medication against professionals strong advise and despite their attempts to section me during this process, (told I would be on drugs for the rest of my life), and finally told by a psychiatrist how he though I had experienced a miracle and was in full recovery, despite it being virtually unheard of for someone with such a diagnosis as mine to do so. As someone who has worked in the mental health field and experienced it myself, I have always felt something is missing, unable to put my finger on the ‘something’. Because of my experience and the incredible transformation that has, and still is occurring in my life, I see more the missing link. It is the whole ‘spiritual deal’ which, as soon as i say the words, I know can stir up so much ‘stuff’ for anyone reading it. My whole concept of the words spiritual, God, a creator, life energy have also changed massively from my child views of a God, if he existed at all, of a big scary judgemental dude in the sky! And as an ‘ex-bipolar’ service user, I am aware how the whole ‘God complex’ sometimes experienced during a manic phase, easily will cause people to simply attempt to put me in to that category! As I said at the beginning words are just a snapshot moment of writing, and those reading can, on first glance, read it one way and on another day read it in an entirely different way. Isn’t that so? I have attempted to contact both the individuals mentioned above, receiving no reply. Noone, it seems, is interested in looking at this side of things, and by that i do not mean religion. But I cannot deny my ‘spiritual experience’ and how I have changed so dramatically through a treatment called NIS (Neural Integration System) and yoga (in it’s true spiritual sense and so, not as ‘just’ a physical exercise). It has been bloody difficult, but so incredibly empowering, uplifting and the contented peace I now feel is beyond profound. When I talk of God, I am talking about feelings, about feeling contentedly happy and blissful despite whatever shite is happening in life…an inner peace. Isn’t that how we all ultimately want to feel…happy? So maybe it is something to consider.

  • 19helen60

    19helen60 Okay. Having read many of these comments I am surprised that they are primarily from mental health workers meaning a whole host of information is missed. Why the lack of mentally ill. Well I’ve realised. HOW DOES SOMEONE WITH CHRONIC MENTAL HEALTH PROBLEMS COPE WITH THE CONFUSION OF LOGGING ON. I tried to log in but when I did I already had an acc with discus. I had forgotten that.( Any organisational skills I had are out the window). I wondered if it needed my other e mail address but I felt very confused about that as all I could think of was a quote from Hamlet that serves as a password but did I use the punctuation. Then I realised the e mail address I was using was ok and my password was wrong. I tried the one that includes my dog’s name to no avail. Then it said I could get a new password but then it wouldn’t let me. By now all my body was taut and I was beginning to feel distressed. I tried again and success. But not before I had to agree to something and then it gave me a choice. I didn’t want to agree but I was so frightened of having to start again that I may have signed up for anything. I am intelligent but am easily confused. I function very well compared to many people I know who suffer with mental illness. The mentally ill have a wealth of experience that is not mentioned in any text book. Experts believe they know more about our health than they do. I am talking about symptoms of the illness here. I want to be believed. I have suffered for 14 years and am an expert on my own (it belongs to me) illness. I want to write more but I am mentally exhausted right now.

  • Excellent critique.
    ——-
    Why does everyone say ‘medication’ now instead of ‘medicine’? I’m not that old (48), and it was the word they used when I was growing up. Apart from sounding more pompous, how is ‘medication’ an improvement?

  • Crutchbender

    “…bravely confronting an extreme homophobe in Uganda…”

    What a hero. Yawn.

  • Jeff

    Gated Communities

    Gated communities are taking on an important role in modern politics. Donald Trump grew up in a gated community, and made his fortune building gated communities that illegally exclude African-Americans. Trump’s approach is not based on ideology, but on consumer demand, and in particular, the demand of the working class to live in a place where there are no minority groups, criminals, wierdos or politically correct (Catholic educated) people.

    A gated community has a number of characteristics. There is ideally a six metre high concrete wall to keep out intruders. When the wall surrounds a very large number of houses, the average cost of the wall becomes insignificant. Getting past the security guards is like going through customs. Hence there is no crime in a gated community, and children can roam unsupervised in complete safety. Parents can be sure their daughters will not encounter males that would be unsuitable sons-in-law.

    Allotments are typically quarter-acre or five acres (one-tenth or two hectares). Houses are fireproof and of a similar appearance. Services are provided by underground ducts, including pneumatic mail delivery. Television and internet are unobtrusively censored.

    There is a shopping centre with a supermarket and other key shops. Prices are controlled to prevent gouging. There is a club for men and older boys from which women are excluded. On the top of the shopping centre is a hospital and old people’s home overlooking a race track and playing fields.

    There is a non-denomination church, which has leather sofas instead of pews, and wallpaper with pictures of saints like in an eastern orthodox church. The priest is a family man employed by the management committee. There is a co-educational school, so that if children conceive a passionate desire for a classmate, it will be someone of the opposite gender. The school has international baccalaureate and no homework.

    Once people move into a gated community, it occurs to them that, instead of their having to move into a gated community, it would be better if the “undesirables” were forced to live in ghettos, or were kicked out of the country altogether. No doubt this is what Donald Trump has in mind. The Conservative Party should take on board this trend in modern living and become the party for people who live or would like to live in gated communities. ew