Are you a good person?

Are you kind to fellow humans—and all creatures great and small?

Do you support worthy charities, help those in need, and do good work?

Or do you have a dark side? Is there part of you that wants to lie and cheat and manipulate situations to your advantage? Are you interested in enriching yourself—even if that comes at a cost to others?

The answer is: All of the above. In the fine words of that great philosopher Paul McCartney: There is good and bad in everyone. Humans are capable of astonishing acts of courage and bravery, but under certain circumstances we might be utterly spineless, cruel, greedy or depraved. To deny these things in you—what Carl Jung called the shadow—is to project them unconsciously onto others.

“I’m a good person,” a client said. But all around her—her husband, her children, siblings, parents, neighbours, immigrants, foreigners—were bad. This construction of the world left her lonely and disengaged, holding on only to her sense of superiority. She came to therapy when it came crashing down.

“I’m the bad guy?” says Michael Douglas at the end of the movie Falling Down. Robert Duvall, the cop aiming his pistol at him on the Santa Monia Pier, nods. 
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“How’d that happen?”
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A few weeks ago my therapist sent me a link to an extraordinary song that explores these themes. Hi Ren went live on YouTube on December 15 last year. When I first saw it, it had surpassed 5 million views. Today it’s reached 8.2 million and it's rising super fast. Word of mouth: This is the song of our time; a human anthem.

It starts with Ren, wearing a hospital gown, being wheeled into a semi-derelict room by a man with a pig’s head and a bloodied butcher’s apron. Ren is obviously a patient. He too is perhaps feeling derelict and abandoned—and powerless too in the hands of those charged with his care.

He starts playing the guitar.

It’s beautiful. An acoustic guitar. A pleasing melody. The incongruity of the surroundings. But he’s tugging at the nylon strings a bit hard. A bit twangy. Aggressive considering the sweet Flamenco notes that fill the room.

Then Ren opens his mouth and the melody is joined by a wail of wild, high-pitched half notes. It is otherworldly. It is perhaps something like the human mating call before we learned to speak, or the dawn chorus in Hades. We are drawn to this—we willingly enter his beautiful madness.

And then the rapping starts.

In his famous Red Book Jung attempts to commune with his own soul.

“ ‘My soul, where are you? Do you hear me?' he starts. 'I speak, I call you – are you
there?’ ”

In this piece of work, Ren opens with a salutation from his shadow to his ego.

“Hi there, Ren,” he hisses. “It's been a little while, did you miss me?”

This is the opening salvo in a blistering verbal assault from Ren’s inner critical voice.

Replies Ren:
“I’ve been taking some time to be distant,” he explains.
“I've been taking some time to be still.
“I've been taking some time to be by myself since my therapist told me I'm ill.
“And I've been making some progress lately,
“And I've learnt some new coping skills”

The critical voice is extremely skeptical:
“Ren, you sound more insane than I do,” he says.

He mocks Ren for imagining that some standard course of treatment—take another pill, the sound of white noise, a 10-step program—will make any difference, and ridicules his musical ambitions.

The argument hots up until the critical voice thunders his authority. He is the snake in Eden. Lucifer. Antichrist. Mephistopheles. Satan.
“I am you, Ren, you are me.”

Who is Ren actually, this Keats-with-guitar? Where did this guy come from? You could be excused for imagining he just picked up a guitar one day in a psych ward and discovered his madness instinctively knew how to play and had something to say.

Ren Gill was actually a talented musician in his youth. He started out making beats in his bedroom at 13, then went on to Bath Spa University to study music performance. One day in 2009, busking in his hometown of Brighton, he was spotted by a talent scout and snapped up by Sony Records.

The childhood dream swiftly turned into a nightmare however. Ren woke one morning feeling utterly lethargic, drained, and aching all over. He started having panic attacks. He’d stay in bed. He said: “My life changed overnight, I woke up one morning feeling like I'd been spiked—my personality disappeared.”

He entered the mental health system. He was put on antidepressants. Antipsychotics. It's not hard to imagine the kinds of interpretations psychology offered up for his illness—he was probably told for example that he was depressed, suffering from low self-esteem, bipolar, afraid of success, delusional, paranoid, mad. In some cultures he would be considered possessed, in need of an exorcism.

​The truth, discovered many years later, was that he had a longstanding untreated case of Lyme disease, the complications of which still impact him today. Ren’s health problems were perhaps not manifestations of some inner psychic conflict. He was bitten by a tic.

He has struggled. But perhaps the struggle, the suffering, is integral to his genius.

In the final stanza, Ren refuses to back down, and stands to face his demon:
“I go by many names also,
“Some people know me as hope,
“Some people know me as the voice that you hear when you loosen the noose on the rope.”

I’ve watched Hi Ren countless times now, but this passage, this lone shriek in the cold, silent void of a long and desolate night, this absolute guttural refusal to quit, still reverberates. This is courage. And if you going to live, stand in the fire, sing at the top of your lungs! Ferocious, persistent, immortal! 

The Hollywood movies might leave it there. The good guy narrowly defeats the bad guy, the evil forces are vanquished, and the credit roll as a beautiful melody transports us back to our lives.
 
Critical self
I have worked with many clients whose lives are made wretched by an invisible sargeant major who subjects them to a permanent harangue of negativity. It can come as quite a shock to discover that some of the nicest people are often subject to a totalitarian inner form of government—a brutal, relentless inner monologue that is with them 24 hours a day.

Perhaps it is an internalised strict parent, sibling, school bully, racist, sexist, homophobe, ableist. The child who is abused by a parent may conclude that love and abuse are indivisible. Lorna Smith Benjamin describes masochism as a gift of love to the original abuser.

Perhaps you experienced a traumatic event or time in your life, one that was so terrible it couldn’t be processed so was instead dissociated, divided up into images, sensations, stray thoughts and emotions. You bury these fragments in a deep hole at the far end of the garden, but to your great dismay they keep coming back. The past reverberates in the present. Time in itself does not necessarily heal.

I’ve also met people who might have had perfectly idyllic childhoods yet still berate themselves mercilessly for every bone-headed move, bad-hair day or dumb remark. Perhaps your critical voice starts out by alerting you to where you might have room for improvement, acting in your best interests, but over the years it can become domineering and disempowering. 

Incidentally, if “the voice” is more than a thought or a feeling but is experienced as an actual, heard voice, some people might conclude that you must be mad, possessed and probably dangerous. And while such voices may point to the consideration of psychosis, it does not prove it. Many people hear voices at times for a variety of reasons.
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Therapy might enable a client to develop a greater awareness and understanding of their inner critic. We might imagine it is an actual person—what age, gender? Remind you of anyone you know? The client might have a conversation with their critical voice. It can be useful to think of humans as being made up of multiple “selves,” lots of disparate strands in the tapestry. They all inhabit our being in a loose confederacy. And the client might find some other sentiments in this “community of selves” that can challenge and counter the inner bully.

The shadow
Sometimes, however, therapy attempts to go too far in expunging any negativity or nastiness. Jung argued we not born pure, but whole. We cannot edit ourselves to be merely good. We can never be untethered from our shadow. In Memories, dreams, reflections, Jung called the shadow—“everything that the subject refuses to acknowledge” about themselves (1995: 418).

Pure goodness becomes insipid. Heaven, with no shade, is no place for humans—a place, as David Byrne sung, where “nothing ever happens.”

Anyone who denies their inner propensity for evil as well as good will find that it manifests itself in unanticipated ways.

To make light—to live—is to cast a shadow. This is a chiaroscuro world. 

Artists, poets, writers, musicians, comedians, people who bring light to the world, must also experience darkness. 

And the shadow, by the way, doesn’t always have to be something bad. You might disavow your own brilliance, or talent, or potential for success. The more a person identifies with and invests in one polarity, the greater the opposite polarity grows in the shadow. 

We don't like bad stuff. The child who has not yet learned to tolerate and accept anger will hand it off, screaming at the grown-up: “Why are so angry with me?"

Any emotions, beliefs or characteristics that don't fit with your carefully-crafted, social media-ready self-image are simply projected onto others. Your partner—that's the easiest place to start. Then there are family members—one sibling is often cast as "the bad one"—neighbours, that asshole at work, men, women, black people, white people, those people over there, others.

The targets for projection and scapegoating are plentiful. Twitter is a very shadowy place indeed.

Writes Robert A. Johnson in Owning your own shadow: “Probably the worst damage is done when parents lay their shadow on their children...If a parent lays his shadow on a young child, that splits the personality of the child and sets the ego-shadow warfare into motion."  (1991: 34).

So how do you find your shadow? Ask yourself: Who do you judge? Your enemies, the people you dislike the most, have much to teach you. For they are you.

Projecting your shadow isn't just bad for others. It's bad for you too. Continues Johnson: “To refuse the dark side in one’s nature is to store up or accumulate the darkness; this is later expressed as a black mood, psychosomatic illness or unconsciously inspired accidents. We are presently dealing with the accumulation of a whole society that has worshipped its light side and refused the dark, and this residue appears as war, economic chaos, strikes, racial intolerance. The front page of any newspaper hurls the collective shadow at us. We must be whole whether we like it or not” (1991: 26).

You want world peace? To start with, stop pointing accusatory fingers every which way, and instead take a look inside.

If we can own our shadow we can develop some conscious control over it, rather than have it unconsciously express itself in disastrous ways. And if we can accept that we are all flawed, vulnerable, insignificant, ignorant, that life is hard but also beautiful, that not one person on this planet knows how or why we are here, then we can perhaps be more empathic, more forgiving, kinder. We can greet each other. The words “human” and “humility” come from the same root, the Latin word “humus,” meaning earth or ground. We are not celestial beings. We return to the earth. Ashes to ashes, dust to dust.

”No one can escape the dark side of life,” writes Johnson. ”The balance of dark and light is ultimately possible—and bearable” (1991: 15).

Let's dance 
At the end of Hi Ren, this remarkable young man puts the guitar down, looks right into the camera and delivers a powerful soliloquy.

“It wasn't David versus Goliath,” he says, “it was a pendulum eternally swaying from the dark to the light. And the more intensely that the light shone, the darker the shadow it cast.
​
“It was never really a battle for me to win, it was an eternal dance, and like a dance, the more rigid I became, the harder it got. The more I cursed my clumsy footsteps, the more I struggled. And so I got older and I learned to relax, and I learned to soften, and that dance got easier. It is this eternal dance that separates human beings from angels, from demons, from gods. And I must not forget, we must not forget, that we are human beings.”

Among the tens of millions of deaths resulting from the last great flu pandemic 100 years ago—the so-called Spanish flu—was Sophie Halberstadt, the fifth of Sigmund Freud’s six children. She died on January 25, 1920.

Freud wrote to his mother the next day, informing her of the terrible news, and adding: “I hope you will take it calmly; tragedy after all has to be accepted. But to mourn this splendid, vital girl who was so happy with her husband and children is of course permissible.”

The next day he wrote to his friend, Oskar Pfister, that “sweet Sophie in Hamburg had been snatched away by pneumonia, snatched away in the midst of a glowing health, from a full and active life as a competent mother and loving wife, all in four or five days, as though she had never existed...The undisguised brutality of our time is weighing heavily upon us. Tomorrow she is being cremated, our poor Sunday Child!”

There was no comfort in religion for Freud—famously atheistic, he regarded a belief in god as an infantile need for a father figure. Writing of Sophie’s passing to psychoanalyst Sandor Ferenczi, Freud said: “as a confirmed unbeliever I have no one to accuse and realize that there is no place where I could lodge a complaint.”

Sophie left behind two sons. The younger one, Heinele, was just a baby at the time. He was, wrote Freud, “physically very fragile, truly a child of the war, but especially intelligent and endearing." When he too died, three years later, of tuberculosis, Freud was undone. Another three years on, Freud wrote to fellow analyst Ludwig Binswanger: “This child has taken the place of all of my other children and grandchildren for me, and since then, since Heinele's death, I no longer take care of my other grandchildren and no longer feel any enjoyment in life either."

To British psychoanalyst Ernest Jones he wrote: “Sophie was a dear daughter, to be sure, but not a child. It was ... when little Heinele died, that I became tired of life permanently. Quite remarkably, there is a correspondence between him and your little one. He too was of superior intelligence and unspeakable spiritual grace, and he spoke repeatedly about dying soon. How do these children know?"

Freud had written about grief before as a younger, less blemished man. His landmark paper comparing mourning and melancholia (1917) said the former was a healthy, temporary depression following a loss, a process that when completed successfully allows the bereaved person to live and love again. Melancholia by contrast, more self-defeating, enduring and with no apparent conscious cause, was more problematic. Freud memorably described it as “an open wound.”

But as the losses mount, they can accumulate and sometimes be felt more keenly over time, not less, and the distinction between mourning and melancholia can become blurred by all the tears and the fog of remembrance.

In another letter to Binswanger in 1929, Freud wrote: “Although you know that after such a loss the acute state of mourning will subside, we also know we shall remain inconsolable and never find a substitute. No matter what may fill the gap, even if it be filled completely, it nevertheless remains something else. And actually this is how it should be. It's the only way of perpetuating that love which we don't want to relinquish.”

Freud suffered in his life. A perpetual cigar smoker, he had more than 30 surgeries on a mouth cancer that caused him excruciating pain. He and his youngest daughter, Anna—a famous psychologist in her own right—fled the Nazis n 1938 and moved to London. Freud died by doctor-assisted suicide the following year, three weeks after the start of the Second World War—a war that saw his four sisters murdered in the Holocaust.

The death of Sophie, however, and of little Heinele were defining moments in the landscape of his 83 years on earth.
​
Freud learned that we never really get over life’s biggest losses. What we can do is honour the dead by living—and living well.
 

One of the tropes of a certain brand of conservative media outlet is that Christmas is under threat. The usual suspects are rounded up: The EU, Muslims, immigrants.

Dame Louise Casey, the government’s “integration tsar,” cited Christmas in a report in September, saying: “I have become convinced that it is only the upholding of our core British laws, cultures, values and traditions that will offer us the route map through the different and complex challenge of creating a cohesive society.”

Laws of the land are one thing; British culture and traditions quite another. For the latter, apparently the “integration tsar” doesn’t believe in integration. Shouldn’t she be called the “assimilation tsar”—or perhaps even the “re-education tsar”?

As Santa Claus might say: Ho ho ho.
• A lot of Christmas traditions, like so much of British culture, came from elsewhere. To name a few: Christmas trees were likely a German idea originally; panto came from the Italian tradition of commedia dell’arte; mulled wine from the Ancient Greeks. The jolly, rotund image of Santa famously began in a 1931 Coca-Cola ad.
• “British values” are often described as religious, Christian values. But for the majority of Britons, Christmas doesn’t have much or anything to do with Christ any more. People of no religion now outnumber Christians in England and Wales, and this year the number of people attending Church of England services each week for the first time dropped below 1 million, accounting for less than 2 percent of the population. Non-Christian Britons are no less British.
• Having some sort of celebration in the dead of winter has long been appealing to many people whether religious or not. It was something people did long before the idea was co-opted by Christianity—and long before any politician uttered the phrase “British values.”
• One longstanding Christmas “tradition” is that for many, it’s a terrible time of year. If you are not living the soft-focus, pastel-hued fantasy life depicted in department store Christmas ads, you feel guilty, a failure, literally and metaphorically missing out on the party. Instead of this being a time of light, warmth, food, gifts, singing, laughing and good company, for many it is instead one of darkness, cold, hunger, loss, silence, tears and loneliness. Clients complain of the stress and expense of Christmas, and the pressure to be happy. The Samaritans volunteers are especially busy at this time of year.

No.5: REUNIFICATION
 
The new client, United Kingdom, shuffles into the room and slumps down uncomfortably in the chair. There is no eye contact. We sit in silence. Finally there is a cough and a muffled voice, a sort of low growl: “Don’t really need to be here. Just been feeling a bit down lately.” Another silence. A tear rolls down from Scotland and lands somewhere near Darlington.

Yes, if countries were people, the UK might be looking for a therapist right about now.

It has been having a hard time of late. It was a summer of discontent. Before the Brexit referendum, this was a largely peaceful, united land that prided itself on never losing its great sense of humour, come what may—the land of Monty Python, Alan Partridge, the Office, Mr Bean. A nation that believed in fair play. A creative, resilient, quirky place that didn’t just tolerate difference and eccentricity but embraced it. The land of Churchill (half American), fish and chips (brought here by Spanish jews), beer (probably middle Eastern), sliced bread (American), England’s St. George (from Cappadocia, never visited our islands), Morris dancing (originally “Moorish”), the Queen (at least a little but German). The country whose two favourite dishes are chicken tikka masala and Chinese stir fry. The country that fought fascism and won.
We used to be mostly in the middle, proud of our patchwork cultural history, a big-tent bell curve of British decency, tea and sympathy.
Post-referendum, the bell curve has been turned on its head. The centre has been vacated, and you’re either jeering from the terraces on the star-spangled blue side, shouting “You idiots—what have you done to our future?” or you’re on the other side, amid a sea of red-and-white-painted faces, chanting “Get over it, we won.” With added swear words from both sides, obviously.
 
The UK is at war with itself. When a person feels like that, in crisis, the old ways of doing things no longer work, and nothing seems to make sense any more. Time to take stock—with the help of a therapist, ideally—turn the spotlight on you and your life and, fortified by knowledge and love, make some changes.

​With a bit of luck, the breakdown turns into a breakthrough.

The root of the problem
It can be a small thing that triggers such a crisis. Someone inexplicably bursts into tears getting dressed for work, or their boss finds an empty vodka miniature in their desk, or they shout at a little old lady fumbling in the checkout queue, and their world unravels. It of course can be a big thing, too: illness, redundancy, divorce, trauma, bereavement.
The UK’s problem—manifested by the referendum—began as a squabble within the Conservative Party. Since World War Two, there has been a growing chorus of Tory backbenchers—big and small “c” conservatives—who decry the rise of the European Union. They have tended to see Britain in heroic, benighted terms, as a proud, fiercely-independent land, in living memory the supposedly-magnanimous, beating heart of the biggest empire the world has even seen, shining the light of civilisation into the dark corners of the world and teaching them how to play cricket. The idea of being told what to do by the French, or the Germans, was beyond the pale. Who won the war anyhow? These nostalgic, elegiac chords were played at full volume by the likes of Enoch Powell, Margaret Thatcher and ... Nigel Farage.

When traditional Tory voters began to flee to UKIP, the eurosceptic harrumphs turned into howls.

PM and former PR man David Cameron was facing a mutiny. He hoped to quash it by calling the rebels’ bluff. He called for backup; he took it to the nation, gambling his job, career and the nation’s future.
 
The referendum took on a life of its own. It grew. It turned into a referendum on everything.
• Was it about the EU? Yes, although three recent consecutive eurosceptic Conservative Party leaders, William Hague, Iain Duncan Smith and Michael Howard, failed to gain any traction among voters on the issue. And in the immediate aftermath of the vote, an awful lot of people in the UK Googled “What is the EU?”
• Was it about democracy? Yes, although shouldn’t Brexiteers also therefore be tirelessly campaigning to end the monarchy, abolish the House of Lords, the cronyism of the honours system, the influence of the City on domestic policy, and of Washington DC on foreign policy?
• Was it about immigration? Yes, although overall immigrants are net positive contributors to the British economy, and since the days of the Normans, the Saxons, the Danes and the Hugenots, Britain, British culture and British people have been forged from outside influences.
 
Perhaps what the referendum mostly was about was dissatisfaction with the status quo. As with the unfortunate American embrace of Donald Trump, Brexit was a protest vote against hard times and the struggle of life—exacerbated by a government policy of austerity that crippled poorer parts of the nation—with the finger of blame pointing every whichway: at politicians, the EU, immigrants, refugees, Muslims, “experts,” the Establishment, the media, old people, young people, rich people, poor people.

Let’s hope the sunlit uplands of prosperity that the Brexiteers voted for come to pass. Regrettably, however, it seems more likely that there will instead be much more dissatisfaction to come.

Cameron didn’t expect to lose. There was no plan. More than two months later, there seemingly still isn’t. No one seems to know how or when Brexit will happen or what it will look like. But hey, great news: our passports are going to be blue!
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The person in charge of implementing Brexit—the unelected pro-Remain Theresa May—has to get on with it now, directing enormous time and resources to extricating the UK from the EU and disentangling decades of legislation, and trying to set up new trade deals around the world with countries for whom the post-Brexit UK is, according to some, something of a laughing stock, and who are in the strong bargaining positioning of knowing, and knowing that we know, they we need them more than they need us. The PM also has to deal with all the domestic fallout: the possible disintegration of the UK, businesses threatening to make their own Brexit and head to the Continent, a tanking pound, the rise of racism.

We might spend years at the side of the road, wiping all the mud off our weary old boots while other countries sprint by in new hi-tech gear that was probably made in China.
​

Consider these points (from an earlier post: Does your government make you happy?):
• The Scandinavian system or “Nordic model” of government features high taxes, a large, well-run welfare state, a high standard of free education and healthcare, and low levels of inequality. The machine works for betterment of the people, not the other way round. (In John Rawls “A Theory of Justice,” he demonstrates through his “original position” experiment that if people don’t know how they will end up in an imaginary society, they will generally opt for a fair, redistributive political and economic system that treats all fairly, maximising the prospects of the least well-off.) The Nordic model is a system that appears to make people happy: Denmark and its close cousin Iceland, plus Norway, Finland, Sweden, and the Netherlands, are all in the top-8 happiest nations in the world. Why isn’t such a superior form of governance the rule rather than the exception? (“Yes,” people say, “but these are countries with small populations and low immigration”—as though water, sunlight and soil were only good for some trees but not others.)
 
• According to the World Happiness Report: “66% of respondents in the Netherlands and 61% in Sweden answered that most people can be trusted, compared with just 35% in the US and 28% in Russia. Moreover, comparing the extent of trust in the 1981-84 sampling period with the recent period, trust rose in Sweden (from 57 to 61%), while it declined in the United States (from 45 to 35%).”
 
• Scandinavian cities tend to do well in the famous “lost wallet” experiments in which full wallets are left lying around to see how many get returned or handed in.
 
• The happiest nation, Switzerland, meanwhile, is the closest state in the world to a direct democracy. There are referendums on town, city, district and national level. They don’t just scrawl an X on a ballot paper once every 5 years. The Swiss really have a say in how their country is run. They are invested in their government, and vice versa.
 
The times they are a’changing. Donald Trump’s fearmongering, xenophobia, and foghorn declarations about the virtues of greed are like the terminal groans and expirations of a witless dinosaur, ignorant of his impending extinction.
 
Whether you are a Leaver or Remainer, Brexit showed that the British are hungry for democracy. We want to be heard. Brexit was a crack in the walls of the house that was built on the old order of patronage, privilege and politics as usual—a crack that lets in the light.

Primitive societies kill people, then evolve to enslaving them, then to giving them the vote. The next stage is to listen to them.

After a few months of hearing all the differing viewpoints and “standing in the spaces” between them, the client, our dear old friend UK, started to feel much better. The therapy came to a natural end. “It’s all about considering all the different views, and being fair,” said Scotland, speaking for the whole person, who now was sitting tall and proud and relaxed. “The more we listen to all the voices, the better we feel.”

The cure for a sick democracy, it turns out, is more democracy.

No. 1: ALIENATION 

All was not well in the Kingdom.
Times were hard. People were angry, a lot of them with good reason. After the global financial crisis and six years of government spending cuts, the age of austerity had sent a chill wind through the hills, valleys and high streets up and down the land. It was bleak, especially in the poorest, most neglected rural areas and forgotten, boarded-up English towns, far from Westminster. Unemployment was low, but zero-hour contract arrangements were increasing, and this green and pleasant land now had 1,000 food banks where previously they were rare. Depending on which study you believe, roughly a sixth, a quarter or a third of Britons were living in poverty. Meanwhile, in an already increasingly unequal nation, the richest 1% were getting ever-richer, ever-faster.
Whose fault was it? It must be someone’s fault?
 
The blame game
Human interaction can be a complicated dance around a “Drama Triangle”—the three points of the triangle are labelled persecutor, victim and rescuer. Where are you on the triangle today? And why? Are you a rescuer? Do you ever become so strident in your complaints on behalf of the victims that you become persecutory? Or do you need to be needed, so you do all that you can for the victim, who is as a result disempowered—a classic codependent relationship? Or are you a victim? Do your demands for help become so unreasonable that you become the persecutor and turn the rescuer into a victim? The roles can change in a second.
Whether within families, between work groups, cultural groups or even between countries, these roles are remarkably fluid and heavily dependent on the eye of the beholder. This was the case in the run-up to the Brexit referendum a week ago as the actors took up their positions on the stage:

​A world of worry
This week saw a new study on global mental health. To no one’s surprise, it turns out that if you are poor, you are less likely to have access to help.

The research, published in Lancet Psychiatry, argues for greater funding, claiming that the economic benefits of treatment greatly outweigh the costs: For every dollar spent on improving treatment for depression and anxiety, the return on the investment could be fourfold or higher in terms of increased productivity and health.
"This analysis sets out, for the first time, a global investment case for a scaled-up response to the massive public health and economic burden of depression and anxiety disorders," write the authors, led by Dan Chisholm of the World Health Organization's Department of Mental Health and Substance Abuse.
 
Almost a third of humans experience common psychological ill-health at some point during their lifetime. The vast majority live in poor countries, but clinical care resources are predominantly found in wealthy countries. Low- and middle-income countries spend less than $2 per year per person on the treatment and prevention of mental ill-health compared with an average of more than $50 in high-income countries.
According to Nature: “A teenager in Afghanistan seeking mental-health care does so in a country that has 1 psychiatrist for every 10 million people, not 1 per 5,000, as in, for instance, Belgium. But no country has sufficient numbers of trained mental-health-service providers. Nearly one-third of the US population lacks adequate access to mental-health-care providers. There are similar shortages in parts of countries as diverse as Australia, Canada, Finland, France, Japan, New Zealand and Slovakia. Even in wealthy countries, 40–60% of people with severe mental disorders do not receive the care they need.”
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Mental health has received very little attention in terms of large-scale global health initiatives compared to say malaria, or HIV. That is slowly changing. There is now some political consensus around mental healthcare, both at home—it was a hot topic in the General Election last year—in America, and transnationally. It’s terrific that as of last September, mental health is now included among the United Nation’s Sustainable Development Goals.
There are some impressive programmes that aim to create a more level playing field. The UK-funded Programme for Improving Mental Health Care (PRIME), for example, is a consortium of organisations brought together to scale up mental-health services in Ethiopia, India, Nepal, South Africa and Uganda, taking an informed, integrative approach in these countries with help from community advisory boards that include district health administrators, service users, traditional healers and police.

All well and good. But there are questions. Take 5:
1. Is this all window dressing, a token public relations exercise that diverts attention away from the real business of globalisation—making money and preserving power by and for those that already have it?
2. Do the big pharmaceutical companies have a hand on the lever, attempting to create and colonise large new markets for their patented medications?
3. Is the need for some kind of responsible global governance being served by unelected bodies like the World Bank, IMF and WTO which cater to the “prosperous few” at the expense of the “restless many,” in the words of Noam Chomsky, or like the UN’s WHO which, in this latest report at least, likes to regard people as mere economic units?
4. Could global mental health programmes become a form of cultural imperialism and control, as some have argued, trampling over local norms and practices and instead imposing monolithic “one-size-fits-all” western solutions?
5. If you don’t have access to drinking water say, or your children are starving, doesn’t counselling come fairly low down on the hierarchy of needs? The Indian government offers counselling to help farmers, for example--5,650 Indian farmers committed suicide in 2014, an average of 15 a day. But perhaps what they most need is better financial security. And some rain.

​Overall, the growing domestic, international and global attention paid to mental health is a good thing. But the implementation needs to be done the right way. Culturally-sensitive, local, diverse “bottom-up” mental health programmes are better than imposed, dogmatic, uniform, “top-down” western solutions. The book “Global Mental Health” recommends the liberal use of anthropologists and indigenous experts.
And underscoring all initiatives should be a recognition that mental ill-health is often the symptom, and economic disadvantage the cause. Not the other way round.
Whatever your language, it’s good to talk. Every country on earth could use more counsellors.
But it’s hard to pursue happiness, or perhaps Freud’s rather more modest goal of “common unhappiness,” without safety, food and water, and a roof over your head.
No amount of counselling will take away poverty and inequality.
—John Barton
 
 
U.K. NEWS
 
Mental health issues affect 8 out of 10 doctors
New Statesman
 
Doctors have a hard job. Every day they have to deal with difficult, demanding and demeaning people—and that’s just the politicians! No wonder 82 percent of English doctors have had episodes of mental illness:
 
When medical students enter university, their mental health is no different from that of the rest of the population. By the end of their first year, however, it is significantly worse. Stress accumulates throughout their training and, for many, things do not improve. A new study demonstrates what a problem this has become – especially for the doctors involved.
Debbie Cohen and colleagues at Cardiff University carried out a survey of almost 2,000 British doctors at various stages of their career. Of these, 60 per cent had experienced mental illness (the figure is 82 per cent in England) but most had not sought help.
Even the doctors don’t see it coming. In the survey, most medical professionals who have never experienced mental health problems say that they would disclose any problem that arose. But attitudes change when it actually happens. “You don’t do what you think you would do,” Cohen says.
The figures differ according to stage of career. Trainees and junior doctors are less likely to admit to having a problem – perhaps unsurprisingly, given the perception that it may damage their future. Disclosure rates also differ by career track. Among GPs, 84 per cent say that they would disclose; 39 per cent do so. Trainees disclose at the same rate as GPs but are more aware that they won’t: only 62 per cent say that they would disclose a mental illness. Locums and specialist staff are the least deluded and the least open: they acknowledge the lowest likelihood of disclosure (60 per cent) and they follow through, with 38 per cent making a disclosure of an issue.
 
• Mental health patients wait 'years' for treatment (BBC News)
• Trafficking victims in Britain suffer mental health problems (NewsDaily)
• Tragedy as nine young people died while patients in mental health units (Mirror.co.uk)

U.S.A. NEWS
 
NY Jets wide receiver Brandon Marshall envisions AI bringing mental health to the masses
TechCrunch
 
New York Jets wide receiver Brandon Marshall paid a visit to Silicon Valley this week to explore opportunities and potential partnerships with tech companies around mental health issues. Part of the reason for his visit was because, in 2011, Marshall was diagnosed with borderline personality disorder. He spent three months in an outpatient program and now recognizes that what he went through wasn’t unique.
“They’re universal issues — things we go through just as young adults trying to find ourselves and navigate through the world and with all of the stresses and challenges,” Marshall told me. 
Since his diagnosis, Marshall has wanted to use his celebrity status to raise awareness about mental health issues, which are still, unfortunately, stigmatized in our society. That’s ultimately the impetus for Project 375, co-founded by Marshall and his wife, Michi Marshall. With Project 375, the goal is to raise awareness around mental health issues — something one in five adults in America experienced last year, according to the U.S. Department of Health & Human Services.
“I always say, football is my platform, not my purpose,” Marshall said. “There’s a unique opportunity where there’s 100 million avid football fans that I can speak to and talk to every single day because they follow football.”
 
 
WORLD NEWS
 
• Spiritual counseling at Turkish hospitals addresses patients' emotional needs (Daily Sabah)
• Challenges that African cultural beliefs poses to mental health (GhanaWeb)
 
 
VIEWPOINTS
 
Must a mental illness be revealed on a first date?
By “The Ethicist”—Kwame Anthony Appiah, The New York Times
 
When you grow close to another person, the unspoken covenant is that you’re not holding back a big, relationship-relevant secret. Unless you’ve said so, the assumption is that you’re not the princess of Ruritania, or living under witness protection, or struggling with a serious illness. Intimacy and candor have to be calibrated to some degree. One risk is that someone pulls away at once because he can’t deal with your history of mental illness, but another is that he pulls away later because you haven’t been honest.

There was a time when young children were allowed to be children.

​Primary school was about learning how to play, have fun and make friends. Happy children are more likely to learn and make the world a better place than unhappy ones.
Childhood hasn’t been cancelled exactly, but it is under extreme attack, as I’ve written before (“Suffer little children”). Today's subjects: stress, self-harm, suicide.

​This week saw the launch of a campaign for universal access to school-based counselling services.
Reports the story in Schools Week: “A motion being put to the Association of Teachers and Lecturers’ annual conference in Liverpool, which calls for better promotion of mental health awareness in schools and a campaign for all pupils in England to have access to a counsellor, is expected to pass with the backing of the union’s leadership.”

There is certainly a need:
• One in five children have symptoms of depression and almost a third of the 16-25-year-olds surveyed had thought about or attempted suicide. In Ireland, children as young as five are thinking of suicide.
• A World Health Organisation survey in 2014 revealed a fifth of 15-year-olds in England said they had self-harmed over the previous year.
• An ATL union survey of its own members revealed that 48 per cent of respondents had pupils who had self-harmed, and 20 per cent knew pupils who had attempted suicide “because of the pressure they are under”.
General secretary Mary Bousted said it was “horrifying” that so many young people many are self-harming and contemplating suicide.

Increase paperwork until standards improve!
There is more testing, more homework, and it starts earlier. (Homework for 5-year-olds? Really?). Teachers are overworked and underappreciated (and underpaid), frantically trying to get results, write up reports, check all the boxes and generally enact the latest keep-up-with-China government initiative, all set against a backdrop of cuts in funding and services and in many cases financial hardship at home. The creative, nurturing, qualitative skill of teaching has been turned into a bureaucratic, morale-sapping, quantitative exercise in stress, low-grade trauma and Ofsted reports, one that kills joy in the classroom, erodes resilience and is creating a whole new generation of children who as adults will be susceptible to mental and physical ill-health.
There are roughly 200 governments around the world—200 education policies (or lack thereof), 200 places to look for examples of good ideas and bad ones, 200 petri dishes.
Why fawn over China—do we really want to look to an undemocratic communist government with a terrible human rights record for child-rearing tips? How about looking instead to the more relaxed approach of the Scandinavian countries, especially Finland, where education is free, safe and friendly, school starts at age 7, teachers are allowed to teach, and children are allowed to be children rather than treated as future economic units. Finland’s less-is-more education system has been described as the best in the world.

Mental-health difficulties are the leading causes of disability worldwide—almost a third of people globally will experience mood, anxiety or substance-use problems in their lifetime. The best antidote is a happy childhood.

​As noted philosopher Whitney Houston put it:
I believe the children are our future
Teach them well and let them lead the way
Show them all the beauty they possess inside
Give them a sense of pride 
 
--John Barton