Not an illness? A response to the British Psychological Society report, ‘Understanding Depression,’ October 2020

Trigger warning: suicide and self-harm

It’s early March 2020, a few weeks before lockdown. I’m standing on a bridge over the M25. I climbed out of a window to get here. My husband is taking our daughter to school. He’s locked me in the house and taken my car keys, knowing I’m not safe to be left, but nothing is going to get in the way of my plan to jump off that bridge.

Or, it’s May 2019. I’m in my psychiatrist’s office, my wrists bandaged. The voices in my head are telling me I need to die. I *need* to die. The doctor has left the room to organise a Mental Health Act assessment. I’m trying to escape the room, but my husband is physically blocking the door. We’ve been told that if I do manage to get away, the police will be called.

Or, it’s April 2017. I’m in a psychiatric hospital. I’ve just been detained under section 5(2) of the Mental Health Act for trying to get them to discharge me. I’m curled up on the floor of my bedroom, shaking from head to toe. I can’t do this any more: this is simply more than any human being can be expected to endure.

Or, it’s January 1995. I’m not quite 16. I’ve just seen a psychiatrist for the first time. I’ve been referred because I’m suicidal, or, as the doctor writes in my report, ‘at risk of self-destructive behaviour.’ I’ve already tried to kill myself once, but I didn’t take enough tablets and I’m still here – but I don’t want to be. Even though I have a loving family, a boyfriend (who’ll later become my husband), good friends and am on course to get straight As in my GCSEs.

My life, almost since I can remember, has been plagued by recurrent episodes of paralysing depression. I’ve tried to end my life more times than I can remember, and my body is covered in scars. I’ve been in ambulances, in intensive care, and sectioned in a psych hospital. I’ve been a missing person with the local police force searching for me.

But according to the British Psychological Society (BPS), I’m not ill: I have what they describe in their new report, Understanding Depression, as ‘a common human experience.’

I’m no ‘snowflake,’ and I’m not easily triggered, but reading the report has left me with stinging eyes and pounding heart, and a sick feeling in my stomach. How can a supposedly respected authority on mental illness have reduced my lifelong journey with depression as, in their words, something we experience ‘just as we experience anxiety, anger, or even love and joy?’

I’ve known those experiences; we all have. I’ve felt sick with anxiety before taking exams, and full of fury when I’m hormonal and the house is a bombsite. I experience love every day – towards my husband, children, friends and cats – and only yesterday, felt the unbridled joy of seeing a West End show for the first time in months.

These ‘common human experiences’ have no relation whatsoever to the severe, enduring clinical depression that leaves me bleeding on the bathroom floor or semi-conscious in the back of an ambulance.

According to the BPS, though, clinical depression isn’t even an illness. ‘Throughout this document,’ it says, ‘we highlight debates about whether and when it might be useful to think of depression as an illness. In recognition of these debates, we use quotation marks around psychiatric terminology such as “clinical depression” or “major depressive disorder.”’

The mental illness – or ‘experience,’ as the BPS would say – has been reduced to insignificance by those inverted commas. Instead of being ill, I’m ‘ill.’ The speech marks patronise and humiliate me; they give me a metaphorical pat on the back and a condescending, ‘there, there.’

It gets worse.

‘People often assume that mental illnesses “exist” in the same way that broken bones exist, and that there are independent tests for them such as blood tests or scans. However, this is not the case for mental health problems,’ the report continues.

True, there are no tests for the biochemical imbalances that can tip me from stable to clinging to a bridge within the space of a few days, no brain scan that shows broken areas in my head. But to say my illness – the illness of millions – doesn’t exist because it can’t be evidenced? I can’t accept that.

If my depression were simply me ‘milking’ a ‘common human experience,’ how do they explain the fact that medication (usually) keeps me stable, or that trying to come off my anti-psychotic led to the best part of two months in a psych unit? How do they explain the way my mood can crash from totally fine to abject, suicidal despair with no external trigger?

It’s gaslighting on an extreme level, and what makes it desperately sad is that it comes from an authority that should be firmly on the side of those of us who live with mental health conditions like major clinical depression (should I put that in quotation marks?).

Yes, the BPS has its own agenda – as a psychology, rather than psychiatry, society, it wants to promote the role of talking therapies as the antidote to depression.

But its report totally discredits depression as a potentially serious – potentially life-threatening – illness. And that is deeply damaging: we depressed people often feel like we’re frauds, burdens on the system, putting it on, and the oh-so-ironically named Understanding Depression rubs that salt even deeper into the wound.

As a young teenager, in what my then psychiatrist described as ‘bleak despair,’ I was afraid to tell anyone about my depression for fear of what they might think. Twenty-five or more years on, society is getting much better at understanding, and reducing the stigma around, mental illness. But the BPS has undermined all that progress.

How can anyone take depression seriously if top psychologists have dismissed it as a ‘common human experience?’ How can people who are suffering reach out for help – as we’re always being told to do – when the experts are telling us it’s not even an illness?

Understanding Depression is intended to be read by people with depression (I sense an element of Schrodinger here: is it real or is it not?), friends and family, and service providers. It has the potential of a huge reach. And it has the potential to do huge damage.

Right now, I’m glad that I’m in a strong mental state, and not standing on that bridge waiting to jump. Because had I read the report while in a severe depressive crisis, it would have pushed me – literally – over the edge.

10 thoughts on “Not an illness? A response to the British Psychological Society report, ‘Understanding Depression,’ October 2020

  1. Thank you very much for your brave and spot-on critique of the BPS report! As a psychiatrist, I had a very similar reaction to the BPS’s bland and anodyne presentation of depression. We both know that major depression is a serious and often devastating illness, and that new-age psychobabble from the BPS cannot mitigate the suffering and incapacity it often produces. Your rejoinder deserves a very wide audience, and I wish you all the best.

    Kind regards,
    Ronald W. Pies, MD
    Professor Emeritus of Psychiatry
    SUNY Upstate Medical University

  2. Thank you, Ms. Dimbylow. I am considering doing a piece for Psychiatric Times on the BPS report. I may want to include some quotes from your blog. If I do that, are you comfortable with my using your full name? The paper normally does not cite anonymous sources. However, if you are in any way uncomfortable with that, please feel free to say so. And thanks again for your great blog!

    Best regards,
    Ronald W. Pies, MD

  3. Many thanks! I will keep you posted. (It may be a week or more before the piece appears on line). –Regards,
    Ron Pies MD

  4. Hi, Ms. Dimbylow–The article now appears in Psychiatric Times, at this link:

    The length limitations of the piece did not permit me to include many noteworthy sections of your blog, but I hope that the quotes that were included convey the most important points you make. Also, the article links directly to this website, so readers can take in your entire blog.

    Thank you again for permitting me to cite your work!

    Best regards,
    Ron Pies, MD

    • Thank you so much for sending the link and including my voice. I’m very glad to have been able to contribute. There are a couple of misspellings of my name, if they could be corrected – but not to worry if not. I’ll share the article on Twitter; do you have a personal account?

  5. Hi, Lucy (if I may….). I am glad you were happy with the article, and I deeply appreciate your contribution! I’m sorry I didn’t catch the misspellings of your name in the final paragraph. I will ask the editor to correct that right away! I don’t actually have any social media accounts, but I appreciate your sharing the link to the article.

    Best regards,
    Ronald W. Pies, MD

  6. Pingback: Dr. Pies: Still Going Wrong - Mad In America

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