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Broken Britain on the psychiatrist’s couch


I VERY much enjoyed Theodore Dalrymple’s Spectator article on the state of ‘mental health’ in modern Britain earlier this month. He is among my favourite contributors to the Spectator and it’s always a pleasure to read his take on current affairs. However, as an NHS psychiatrist myself, and one born into the millennial generation of which he so despairs, I thought I would pen a response.

There are many nails which he hits squarely on the head. The leveraging of ‘mental health’ as a means to loaf around watching Netflix at home for months on end, while collecting vast sums of sick and/or disability pay, is one of the most obscene phenomena I’ve witnessed, even in our current age of decadence and decay. I’ll grant that this behaviour appears to be much more likely for people under thirty than over it, perhaps due to the sense of indignity that comes with employing such tactics among older generations, while it is actively encouraged in the younger ones.

Along with Dalrymple, I too have heard people say, ‘I’ve got mental health’ as a bizarre shorthand for ‘mental ill-health’ and it turns my stomach as much as it does his. However, and with all due respect, one can tell Dalrymple’s analysis is outdated by his reference to ‘gender dysphoria’ as a contemporary psychiatric diagnosis. I don’t deny that such terminology is valid or has meaningful value, rather that the profession today is so infected by ‘liberal’ ideology that were I to document such a diagnosis for one of my patients, however appropriate, I’d find myself before a fitness-to-practise committee in no time flat.

While I agree that what we are dealing with is a ‘socio-psychological epidemic’, are not all mental health conditions the result of some combination of social and psychological factors? That does not make them any less real. I would argue mental illness genuinely is increasing in prevalence. Take young women with borderline personality disorder. This used to be a relatively rare condition, one psychiatrists might see a few times in their careers. Now the system is becoming overwhelmed with them. They invariably have had some form of abuse or displacement during their formative years and their brains adapt accordingly, resulting in extreme emotional volatility and impulsivity, becoming a fixed part of who they are for the rest of their lives. There is no cure.

Such patients are filling A&E departments and psychiatric units up and down the map, being admitted, discharged and readmitted in a merry-go-round of melancholia, soaking up what limited resources we have. The opportunity costs are astronomical. They also comprise the vast majority of ‘trans’ patients. Having often been excluded from social groups throughout their adolescence, they are drawn to anything which provides a sense of affiliation like moths to a flame. The wishy-washy psychology teams’ insistence that we pander to their pathology in using their preferred pronouns and names, even during private discussions amongst medical professionals, I fear does them more harm than good.

That’s not to say this is always the case re trans cases: there are a few separate issues here. Firstly, I don’t doubt that there are some rare instances where through a combination of unlucky genetics and hormonal exposure in-utero, individuals exist who have a genuine mismatch between their psychological gender and their physiological one. These are the traditional ‘transsexuals’ of yore, who were around long before the recent epidemic. I’m told we used to make them live outwardly as the opposite gender for at least two years before even considering re-assignment surgery on the NHS, something that would be unthinkable now.

Then there are the blokes who decide at fifty-three that they want to be considered as a woman from now on, much to the mortification of their wives and teenage children. Think the ‘I’m a lady!’ sketch from Little Britain, back when we could still satirise such absurdities without having Plod come knocking at our door. In these instances, we are essentially being made to participate in their sexual fetishes. Finally, there are the young boys and girls (mostly boys) who are just gay, but whose parents have drunk deep from the progressive Kool-Aid and insist they are really a girl trapped in a boy’s body (or vice versa), pushing them down a path of puberty blockers and irreversible damage to their reproductive organs.

This last one I see as by far the most evil, and ultimately as a form of state-sanctioned Munchausen syndrome by proxy. Not long ago this would have been categorised as child abuse and the parents referred to social services for a safeguarding investigation. Today, you are more likely to be referred yourself for raising any such concerns.

These are only some of many issues I see day to day. There are also the young men who’ve heavily smoked weed for years, winding up on our wards with chronic schizophrenia. The middle-aged men who have been abandoned by their wives (and therefore children) to a mainstream culture that despises and belittles them, developing severe depression and suicidality as a result.

One of the saddest things I encountered during my time in perinatal psychiatry was the sheer number of women paying more than 100 per cent of their salary towards childcare costs. Either their mortgage was up for renewal, or they were moving house, but in either case the bank needed to see an adequate combined household income to prove they could afford it. These women despaired of the fact they were being forced to pay through the nose for someone else to raise their children, when they would have much preferred doing it themselves. Apparently it used to be an option for a wife to work; now it has become a requirement if one wants to live in a semi-decent house in a semi-decent neighbourhood, and I doubt that womankind is any happier as a result. 

Ultimately, I see all this as but flotsam and jetsam of the upstream destruction wrought by the sexual, and wider cultural, revolution in the 1960s. Young people in particular seem to be yearning for a sense of purpose and meaning that our society is abjectly failing to provide in this post-patriotic, post-Christian age (I say this as a devout atheist). We teach that our own civilisation is irredeemably wicked, that our ancestors have been uniquely evil and there is nothing whatsoever to feel proud about in our cultural inheritance. So why on earth wouldn’t you look for a sense of belonging somewhere else? Some find it in Black Lives Matter, others in climate apocalypticism; many are finding it in Islam, or throwing in their lot with the alphabet people.

The jig was up the moment sex became separated from reproduction. Our civilisation cultivated and evolved traditions over countless centuries which channelled its youth towards a life of health and happiness. Such as the idea that masculine virtues are a valuable, admired and essential component of society; or the (once default) position that a guy sure as hell better marry you first to stand a chance of getting any serious action. The social stigmas against sleeping around, or having children out of wedlock, undoubtedly did psychological harm to the individuals affected; but it’s patently clear at this stage that the complete absence of such stigmas, indeed the reversal of them and active encouragement of these behaviours, leads to far greater suffering as a result. Who would have thought that the invention of the Pill would increase the prevalence of abortions? Certainly no one at Woodstock.

On my current ward, it’s remarkably rare that we admit a patient brought up by their biological mother and father in the same household. These are the exceptions – the rule is a story of broken homes, of step-mothers and step-fathers and step-siblings; of foster care and neglect and indescribable deprivation. The vast majority of our patients are black and white: Muslims and Jews are massively under-represented. It is no coincidence, I would suggest, that these demographics also have the lowest rates of single motherhood and divorce; with communities who, for better or worse, will rally around in reflexive solidarity when one of their number faces adversity.

For the native English population, this support was once provided by Christianity, ethnic pride and, above all, extended nuclear families. All these psychological buttresses have been kicked away over the decades to leave nothing but the cold, perfunctory and increasingly hostile embrace of the State. 

Evidently it is not enough; not nearly enough. 

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