Mental illness, according to the biopsychosocial model, is understood as a consequence of the interaction of three types of factors: biological (genetics), psychological (behaviors, emotions, thoughts...) and social (environment, social level, educational level...). This evidence, scientifically proven, forces us to act on these three factors
both to prevent and treat disease.
We all suffer throughout life. The integration of suffering, the way in which we face problems, the context in which our existence develops, social support, economic support, training and genetic load, will determine if we develop at some point in our lives a mental illness or not. On the other hand, we must understand that human beings can suffer situations such as
stress and griefbut these are part of the natural processes of adaptation and
must differentiate from mental pathologies.
Hypertrophying diagnoses and pharmacological approaches mutilates the possibility of a cure and curtails the human essence, what has allowed us to evolve as a species is to seek solutions to adversity, it is in our nature.
However, in recent years we have been slipping towards the magnification of the biological factor, both as an explanation of the diagnosis (excess or deficit of neurotransmitters) and treatment (drugs). This biological reductionism that turns the human being into biochemical reactions and secondarily into a diagnostic construct,
plays with the idea that everything can be treated with a drugdespite the fact that the clinical practice guidelines advise another way of approaching anxiety, sleep or emotional disorders, pointing out that "anesthetizing" the symptoms instead of allowing the individual to face what is happening to them, makes their problem chronic.
Spain is the first country in the world in the index of consumption per 1,000 inhabitants of benzodiazepines. The prototype of the tranquilizer consumer is a woman, of a certain age, with basic studies and poor socioeconomic conditions. She is a lonely, sad, perhaps abused woman who nobody listens to and whom a drug helps to silence. Behind the
pandemicThere is more talk about mental health than ever before. Now more than ever, it is absolutely necessary to put mental health at the forefront, at a health and social level, but knowing what we are talking about when we talk about mental health.
In the current social moment, more than ever, there is a danger that we will all be diagnosed with mental illness and require treatment. There is talk on the street, in the media, about the
pandemic fatigue, that we are all ill after the pandemic and it translates into being sick. That is an error.
We must not lose sight of the fact that the seriously mentally ill have been the most affected by the pandemic because not only have they not been able to have access to their routine, their professionals, their treatments, but they also did not have the necessary tools to understand what was going on. We must prioritize our efforts to them, without hesitation, because we risk displacing those who have suffered and are suffering the most, due to excess demand generated by social pressure.
The widespread idea that medicine can solve everything is a self-serving lie. The fact that diagnoses in psychiatry and psychology are non-biological criteria and therefore fungible and interpretable, together with the social demand for immediate healing, without suffering, can lead to the medicalization of any situation in life, turning us into a
society of sick, medicated and self-medicated people.
If it is considered that mental disorders will grow due to the increase in adverse circumstances, it would be logical to act in these circumstances. Promoting personal autonomy linked to the social integration of the different realities where each person is located and having good social capital, linked to training, is essential to develop the mental capacity that will be put into play in the face of life's adversities. From the Left we have to intervene in the social asymmetries that create realities that affect above all the most vulnerable.
Recently, the Ministry of Health has presented after twelve years a new Mental Health Strategy, which replaces the last one from 2009, as a 'road map'. This plan will be valid from 2022 to 2026.
This strategy is based on
10 pillars: autonomy and rights of patients with person-centered care; promotion of mental health and prevention of its problems; prevention, early detection and attention to suicidal behavior; community-based care; a focus on childhood and adolescence; family care and intervention; interinstitutional coordination; citizen participation; training and, finally, research, innovation and knowledge. One of the main improvements provided by the strategy is the broad vision of mental health, with prevention, early detection, community-based care, family intervention; inter-institutional coordination and citizen participation.
As an example of this comprehensive vision, the Minister of Health, Carolina Darias, has defended the value of alliances between the Ministry of Health, the FEMP and the Spanish Network of Healthy Cities (RECS) to achieve the primary objective of promoting, protecting and caring for the health of all citizens and funds are incorporated for the Mental Health Action Plan to improve emotional well-being.
They are committed political initiatives. But, it is essential, necessary and an exercise of responsibility that the development of this vision be monitored especially and closely, providing resources and above all, based on what we already know about the evolution of psychiatry in recent years. In the 1960s and 1970s, the ideological current of anti-psychiatry postulated the social origin of mental illness since 'mental illness' was not considered biological, but rather symbolic and cultural.
We have the experience of what has already been done in the psychiatric reform that began in our country in the 1980s, implemented for ethical and technical reasons. A transformative process that required political and social sensitivity. This reform, crystallized in community psychiatry, is highly threatened by the privatizing tendencies of the health system and by insufficient collective awareness. And this is if because in the 21st century it is the pathology of the individual (anxiety, depression), which serves to name it (depressive, bipolar) and which, under the neoliberal impulse and the liquid values of postmodern society, silences social conscience turning the incapacities of the system and of social protection into an individual failure. In such a way that collective suffering is treated as an individual product, metamorphosing the individual into a patient and, therefore, susceptible to treatment and consumer of drugs.
Psychiatry, due to its extreme dependence on
social politics and due to its technical fragility (easily ideologized) it is very vulnerable to political and media power. Strengthening the public model and the biopsychosocial perspective will require regulatory changes and continuous vigilance as well as taking responsibility, from the public, for the training of young people and future professionals.
Currently, after the largest
socio-sanitary crisis of our generation, we have the opportunity and the responsibility to correct mistakes of the past. We unavoidably need transversal policies where multiple factors are involved that improve people's lives, dignifying it (housing, access to paid employment, community activities, sports...).
We need effective policies, without commercializing public services that guarantee the sustainability of our Welfare State, without leaving anyone behind. We must bet on ethical, ecological and transversal treatments with an eye on the human dimension of people, attentive to their needs, listening to their voice, their story. Only in this way will we achieve a society with the capacity to manage its emotions and suffering, capable of meeting the needs of citizens by preventing illness as much as possible and, after illness, providing them with the care they need in a comprehensive and transversal way. Definitely,
humanize mental health.