​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.”
​
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

Happiest days of your life?
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.

U.S.A. NEWS
 
Beyoncé: 'Women have to take time to focus on our mental health'
USA TODAY
 
A throwaway line becomes a news story when it is uttered by Beyoncé. Here’s the line:
 
"We have to care about our bodies and what we put in them. Women have to take the time to focus on our mental health—take time for self, for the spiritual, without feeling guilty or selfish."

 
Unusual marriage counseling retreats
PR Newswire (press release)
 
Is your marriage all at sea? In turbulent waters? Do you feel as if you are drowning? Maybe this boat in North Carolina could help. But what an unfortunate name! Even Boaty McBoatface would be better!
 
Love Odyssey Charters has announced that it is ready to start booking new marriage counseling retreats. They have re-launched their pilothouse sailboat "Dragon Lady" after its annual maintenance. The company offers an intensive marriage intervention service for couples seeking to revive their troubled relationships. More than a gimmick, the service is based on sound neuroscience according to Dr. Bryce Kaye, psychologist and author of the book "The Marriage First Aid Kit." He explains: "We keep them moving and out of their stuck roles. We sail them from port to port where they stay in quaint B&B's, explore the historic towns and enjoy the down-east restaurants. They are surrounded by beautiful natural scenery on the rivers and sounds of North Carolina. The marriage counseling retreats take place in a cozy teak-lined pilot house of a Finnish-made sailboat. All of this puts them into an exploratory state in which their minds are more receptive to new ideas."


VIEWPOINT
 
Clare Allan:
Why words matter when it comes to mental health
The Guardian
 
It happens all the time. If not every day then at the very least several times a week. Someone describes someone else as a “nutter” or a situation as “mental”, and, listening, I am faced with a choice: to speak or not to speak.
It happens in the media too. And not just in tabloid headlines about “schizos”, “psychos” and so forth. In arts discussions on BBC Radio 4, I regularly hear the word “psychotic” used as a shorthand for lacking in conscience, or “schizophrenic”, when what is meant is in two minds.

The big match 
Who do you support?
Team Body—or Team Mind?

The former adopts the “medical model” approach to psychological distress: the root causes are largely found within the biology of the unwitting individual and the best treatment is medication.
Sample narrative: “I am stressed and can't cope. The chemical levels in my brain are slightly off—I need medication to restore the balance.”
 
The Mind team, by contrast, regards symptoms as manifestations of underlying, unresolved inner conflict which needs to be explored, processed and resolved through talking therapy.
Sample narrative: “I am stressed and can't cope. I am such a workaholic and brutally hard on myself—I now see this as some kind of loyalty to my very strict and punitive. parents.”

Longstanding debate 
In his article “The 'drugs v talking' debate doesn't help us understand mental health," in The Guardian on Wednesday, Simon Wessely, chair of psychological medicine at King's College London and president of the Royal College of Psychiatrists, attempts to build a bridge across the yawning divide.
The longstanding debate, he writes, often “has been caricatured as ‘psychiatry v psychology’, or equally unhelpfully ‘drugs v talking’, or ‘brain v mind’. But these are false distinctions, which don’t help in understanding mental disorders, don’t help mental health professionals, and most of all don’t help patients.”
Wessely argues instead for a pluralistic approach: “As there is incontrovertible evidence that physical, psychological and social factors contribute to the development of mental health problems – in different degrees and mixtures according to the type of illness and the particular individual – it follows that treatments that psychiatrists use can be physically, psychologically or socially based, either singly or more often in combination.”
And, according to Wessely, a pluralistic, multidisciplinary approach is precisely what patients get: “The truth is that up and down the land psychiatrists, psychologists, social workers and other mental health professionals work together in multi-disciplinary teams for the benefits of patients.”
 
All that is missing from the picture he paints is a rose-tinted sky filled with smiling cherubs.

Read more

U.K. NEWS

​Stressed out teachers are turning to drink and drugs
Mirror.co.uk
 
Teachers’ union NASUWT recently conducted a survey of more than 5,000 teachers—the results will be published later this year but the Mirror had a sneak preview:
 
Teachers are resorting to drugs and drink to cope with the job’s stress, a shock poll reveals today.
A tenth say they have been prescribed anti-depressants due to work-related pressures – and 47% have seen a doctor in the last 12 months over job-linked physical or mental health problems.
A total of 22% claim to be drinking more alcohol, while 5% are smoking more tobacco and 7% are using or have increased their reliance on prescription drugs.
Disturbingly, 2% claim job stress has driven them to self-harm.
 
 
Kelly Holmes backs mental health campaign after her own battle with depression
Mirror.co.uk
 
Olympic legend Dame Kelly Holmes has given her backing to the Sunday Mirror’s campaign to raise awareness of mental ill health.
The retired British athlete pledged her support as she prepares to run the London Marathon to raise funds for the charity Mind.
The 45-year-old suffered with depression as she struggled to overcome injuries a year before her double Olympic triumph in Athens in 2004.
Dame Kelly reached such a low point she even self-harmed, cutting herself in the bathroom behind a locked door.
She said: “Having suffered from depression myself, I know how horrendous it is to feel so low and so desperate that you actually want to harm yourself.

​Holding the government to account
Luciana Berger MP
 
Luciana Berger has been busy in her role as the first ever shadow Minister for Mental Health. In her latest newsletter she writes:
 
“Time to Talk day happened and was a great success. The night before, I spoke at a mental health rally in Parliament and Everton FC became the first Premier League football club to dedicate a themed match day to break the stigma around mental health. On Time to Talk day itself I spoke at a Business in the Community event on the importance of mental health support in the workplace, visited the 02 in Slough with Jeremy Corbyn, and spoke at the MQ conference on the importance of research. That weekend I took part in the Southbank Centre's Changing Minds Festival - you can listen to the discussion here.”
If you’re interested in Berger’s newsletter you can sign up here.
 
• Ministers 'letting down mentally ill people' by not collecting data (The Guardian)
• We're being forced to fix our own mental health. And it's not working - video (The Guardian)
• I worked in mental health - and after seeing the effects that austerity had on people, I had to leave (The Independent)
• Wentworth Miller pens powerful essay on mental health in response to body-shaming (The Independent)
​

U.S.A. NEWS
 
Mobile platform Talkspace is the 'Future of Therapy'
New York Daily News
 
After a positive experience of couples therapy, software developer Roni Frank wanted a career change. The result is Talkspace, which offers unlimited access to a therapist for $25 a week:
 
Two years into her journey toward a master’s degree, she “started to realize the mental health system in America is completely broken,” she said. “One in five Americans suffers from mental health issues each year.”
Yet, roughly 70% of those who need help don’t receive it, Frank said. The three main obstacles? Cost, stigma and accessibility.
Most face-to-face therapy runs at least $100 an hour, many feel embarrassed about needing psychological help and getting to appointments can be difficult. Frank was convinced she could do something.
Four years ago, the Franks launched Talkspace with $13 million in venture capital funding. They now have over 500 licensed therapists, who report to supervisors.
Some 200,000 people have used the service, which runs $25 a week. Clients can text, record a voice message or leave s video on the firm’s app as often as they want. Therapists get back to them within the day. 

 
Obama administration pushes Medicaid expansion as mental health solution
U.S. News & World Report
 
The White House on Monday released a report saying Medicaid expansion will help those with mental health and substance abuse disorders, but advocacy groups said more needs to be done to remove other barriers that prevent people from getting care.
The Department of Health and Human Services in its report cited those affected by the country's opioid epidemic and people with untreated mental illness as a needy population that could be helped if states that are resisting expanding coverage to their needy populations under Obamacare committed to the move. Doing so, the agency said, could reach the nearly 2 million low-income people in non-expansion states who have these conditions, even resulting in 371,000 fewer people having symptoms of depression.
"The conclusion is clear: If states are serious about tackling mental illness and opioids, then expanding Medicaid offers a unique opportunity to do so," Richard Frank, assistant secretary for planning and evaluation at HHS, said in a call with reporters Monday.
 
 
Probing the complexities of transgender mental health
NPR
 
Do transgender people suffer more from psychological distress because of discrimination, lack of support and a generally hostile response from society? Or is it inherent to the transgender experience, resulting from gender dysphoria and the conflict of feeling different from your assigned identity at birth? A recent study attempts to find out:
 
The study published Monday in JAMA Pediatrics reveals the difficulty in picking apart this question. It examined mental health and substance use among nearly 300 young transgender women in Chicago and Boston.
Only a quarter of the women were white, and all were between ages 16 and 29. The researchers, led by Sari Reisner, a research fellow at Harvard Medical School and Boston Children's Hospital, found that the rate of psychiatric disorders and substance dependence among these women was 1.7 to 3.6 times greater than in the general population.
 
• Doctors are failing to help people with gender dysphoria (BMJ)

RIP Patty Duke:
A mental health pioneer
Los Angeles Times
 
Long before celebrities shared their private struggles on talk-show couches and social media feeds, actress Patty Duke broke a Hollywood taboo by speaking publicly about her mental health struggles.
Duke, who died Tuesday morning at age 69, was diagnosed with manic depression (now called bipolar disorder) in 1982. Known at the time as the goody-two-shoes child star of "The Miracle Worker" (for which she won a best supporting actress Oscar at 16) and "The Patty Duke Show," Duke revealed revealed a much darker reality in her 1987 memoir, "Call Me Anna," written with L.A. Times film critic Kenneth Turan. In the book, she graphically detailed her turbulent life, drug and alcohol abuse and childhood mistreatment at the hands of cruel managers.
In talking candidly about her mental illness, Duke took on the stigma long attached to the issue. In the years since Duke's disclosure, actresses such as Catherine Zeta Jones, Carrie Fisher, Rene Russo and Kim Novak have spoken publicly about their own bipolar diagnoses, while countless other public figures have talked about their depression.
Upon her death, Duke's son, actor Sean Astin, sought to continue his mother's legacy of bringing attention to mental health, launching a crowdfunding campaign to establish the Patty Duke Mental Health Initiative.
 
 
Legal MDMA could happen by 2021
UPROXX
 
Everything old is new again! Now that we’re finally understanding that some drugs — like marijuana — can be helpful when it comes to treating physical and psychological disorders, more and more studies are popping up suggesting that other drugs such as MDMA and Ketamine might also be helpful… in a medical setting. Don’t put your party hat on just yet (this isn’t happening until 2021 at the earliest), but new research shows that MDMA can be helpful in the treatment of post-traumatic stress disorder (previously, it’s been used in couple’s therapy) and the team that’s been conducting the research will soon meet with the FDA to discuss exactly how to proceed when using Molly as an assist in psychotherapy.
 
 
WORLD NEWS
 
Mapping global mental health research funding
RAND Corporation
 
Rand’s new report maps the global funding of mental health research between 2009 and 2014. Among the findings:
 
• The field of mental health research is large (and growing) and diverse – over 220,000 papers were published between 2009 and 2014, supported by over 1,900 funders.
• The US dominates the mental health research field, being both the largest producer of research (36 per cent of publications) and accounting for 31 per cent of government and charity/ foundation/ non-profit funding organisations.
• Charities, foundations and non-profits form the most numerous group of mental health research funders (39 per cent of the funders identified), but governments fund the most papers, accounting for over two-thirds of the papers with funding acknowledgements.
 
• India: Govt hires stress counsellors for paramilitary forces (India Today)
• Queen Rania of Jordan attends counselling session with Syrian refugees (Daily Mail)
• Psychosocial counselling helps earthquake survivors in Nepal overcome loss (Big News Network.com)

SILLY STORY OF THE WEEK
 
Psychotherapy for depressed rats
EurekAlert
 
Genes are not destiny in determining whether a person will suffer from depression, reports a new Northwestern Medicine study. Environment is a major factor, and nurture can override nature.
When rats genetically bred for depression received the equivalent of rat "psychotherapy," their depressed behavior was alleviated. And, after the depressed rats had the therapy, some of their blood biomarkers for depression changed to non-depressed levels.
"The environment can modify a genetic predisposition to depression," said lead study investigator Eva Redei, a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. "If someone has a strong history of depression in her family and is afraid she or her future children will develop depression, our study is reassuring. It suggests that even with a high predisposition for depression, psychotherapy or behavioral activation therapy can alleviate it."
 
What on earth is psychotherapy for rats, you may ask:
 
Redei and colleagues wanted to see if they could alter the rats' genetically caused depression by changing their environment. They took the depressed rats and put them in large cages with lots of toys to chew on and places for them to hide and climb - sort of a Disneyland for rats. The rats were kept in the playground for one month.
"We called it rat psychotherapy," Redei said, "because the enrichment allows them to engage with the environment and each other more." The results of a month in the playground: the rats' depressive behavior was dramatically reduced.
After the playground psychotherapy, the rats were placed in a tank of water. Their behavior in the tank is a measure for depression. The control rats will swim around, looking for a way to escape. Depressed rats will simply float, showing despair behavior. After the month in the playground, the genetically depressed rats energetically paddled around the tank, looking for an exit.
"They did not show despair," Redei said.
 
The lab-coated boffins also found that it’s possible to make rats depressed (as if being part of this whole sorry enterprise wasn’t demoralising enough for the rats):
 
Northwestern scientists also wanted to see if environmental stress could trigger depression in rats bred to be the non-depressed control group of the experiment. These rates did not show despair behavior originally. The control rats underwent a psychologically stressful situation, which involved being restrained two hours a day for two weeks. After the two weeks, the stressed, control rats displayed depressed behavior when placed in a tank of water.
 
Conclusion: rat depression is not hereditary. A fun, stimulating environment where rats can play makes them happy. Strapping them down for two hours a day makes them sad. I think we knew that already, no? We can draw on decades of qualitative research into depression in another mammal: humans.
This weekend, take a look around your “cage.” Do you metaphorically speaking have “lots of toys to chew on” and “places to hide and climb”? And what restrains you? Unlike the lab rats, we are born free. But, as Rousseau noted, we are “everywhere found in chains.”

On June 23, citizens of the United Kingdom are being asked to vote whether or not we should remain faithful to the European Union.

Should we try to patch things up and make it work? Or, perhaps citing “irreconcilable differences,” opt for a separation and divorce?

Stay or go? Such a stark, black-and-white choice in a scenario characterised by multiple shades of grey. Does it feel too good to leave—but also too bad to stay?

There are push and pull factors on both sides of the ledger:

Stay: pull factors
• We like Europe and the Europeans, and they like us. The way you wear your hat, the way we sip our tea. We learn from each other. Our doors are always open to each other. We’ve known each other such a long time. We’ve been through such a lot. We work well together. We’ve more or less kept the peace for decades and our joint finances are successful. Let’s stay together.

​Your relationship referendum
The EU referendum is powerful metaphor for your more personal, intimate relationships, partnerships, marriages. Are you unhappy? Should you stay or should you go?

Again, there will be a tapestry of circumstances. Some push factors foreclose any other considerations, for example domestic abuse. Others can be big but not necessarily insurmountable, such as an affair or betrayal. And there are always pull factors keeping you together: your shared history, the convenience of the status quo, and, above all, children.

And how will it be on your own anyway? The stereotype is that women feel the immediate emotional impact of a break-up more than men, but long-term fare much better on their own than men do. A piece of research from 1972 suggests that marriage is bad for the mental health of women, which given the power dynamics of some very traditional marriages isn’t surprising, although later figures show no gender difference.

You imagine a glamorous bacherlorhood perhaps, free of obligation and duty, exploring all those things you wanted to do but never had the time. Maybe the reality is you are home alone in an indifferent world. There are no invitations to dinner or weekends away. Just you and the deafening sound of the phone not ringing. Who wants to be lonely? But maybe some loneliness would be good for you?
 
Preliminary investigations
• Jannah Walshe recommends a clear-headed assessment of the relationship—not so much the other person—first alone and then together, with questions like these: Is this relationship serving us both or just the other person? Do I spend more time questioning whether the relationship is right or wrong than enjoying it? Is there more to learn for me in this relationship, or can I best learn and grow outside of this relationship? Would leaving this relationship be an act of self-care?
• Similarly, Bruce Derman Ph.D. offers 7 questions to ask if you’re thinking of divorce, starting with: Were you ever really married? Was there a time when you has an us, with reciprocal, mutual intimacy? Or have you always been a bit like flatmates who sometimes have sex?
• Take Relate’s relationship MOT quiz.
 
It’s good to talk
The best advice if you’re not happy is to return once again to a simple, four-letter-word: talk. It’s not easy, especially if one of the problems in the relationship to begin with was not talking.
• Relationship and marriage expert Dr. John Gottman claims couples wait an average of six years of being unhappy before speaking out. You will never get those six years back again.
• Belgium has the highest divorce rate in the world, 71 percent, and the second-highest suicide rate in Western Europe. These facts are often attributed to “binnenvetter”—a characteristic Flemish personality who bottles things up inside.
• It is so much easier to talk with a mediator, referee, coach, guide—a couples counsellor. Find one online or through organizations like Relate or the Tavistock Centre. In “Hold me tight,” Dr. Sue Johnson advocates “emotionally-focussed therapy”: “seven conversations for a lifetime of love” that explore and promote each partner’s emotional responsiveness to each other. “Emotion comes from a Latin word emovere, to move,” she writes. If a couple is going to reconnect, they have to “let their emotions move them into new ways of responding to each other.”
 
Tough decisions can be made with compassion
• In his book ”I love you but I’m not in love with you,” Andrew G. Marshall says “the ILYB conversation,” with 100 percent honesty, can lighten the path to a relationship renaissance—or to the exit sign. If the latter, the ILYB talk will help you to make sense of the breakup. Having a clear, truthful narrative about why the partnership ended is crucial to the mourning process—to be left, cheated on or suddenly “ghosted,” without explanation, can cause months and years of misery.
• Whether you stay or go, it’s never black and white, and you have some control over what the shades of grey look like. In “Rewriting the Rules,” Meg John Barker writes that you don’t have to follow the old stereotypical rom-com/sitcom rules of a break-up which dictate it’s completely over, there’s a good guy and a bad guy, and the former will never speak to the latter again. Relationships don’t end, says Barker, they change. Breaking up with someone with love and respect can spare a lot of pain all around.
 
Stay or go? Or something else? Perhaps if you listen, you might just hear the generous, loving voice of your own wisdom. It knows it's not all your fault. It knows it's not all your partner's fault, either. It has compassion for you both.  It knows what to do. Trust it.

​To partners past, present and future—to Europe—let’s give thanks, and be grateful. We had some really special times together, didn’t we? We’ll always be there for each other, on some level. Things die, love lives on.

​So it’s Thanksgiving Day in America, an annual tradition that dates back to 1621, a day for family, gratitude and generosity. A day of eating a big roast (all that tryptophan will make you sleepy—a whole nation sedated). A day of watching the big NFL games on TV (team sports are a safe proxy for aggression and violence—a whole nation pacified). And above all, a day to give thanks (a whole nation made grateful).

There is an idea from the positive-thinking end of psychology that regularly expressing gratitude makes you happy. Some people make every day a day of thanksgiving. There’s a lot to be said for that. You can spend your energies on the half of the glass that’s empty, or you can be energised by the half that’s full. As Victor Frankl wrote in his book on surviving the Holocaust, Man’s Search for Meaning: “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances.”

It’s one thing for you to choose your attitude—to accentuate the positive in your life, for example, or to give thanks. But it’s quite another for someone else to demand it. Not even your psychotherapist, or Bing Crosby, and certainly not your government, have the right to that. To eliminate the negative, even if that were possible, would be to deny the reality of your situation, your feelings, and an important part of you.

On a national level, positive thinking decrees carry a kind of totalitarian message of the continue-flogging-until-morale-improves variety. There’s something slightly creepy about Bhutan’s state-mandated “happiness” initiative, or the United Nations’ “International Day of Happiness.”

To Native Americans, Thanksgiving is a travesty—it should be a day of mourning. University of Texas professor Robert Jensen argues for turning it into a National Day of Atonement to acknowledge the genocide of America’s indigenous people. Not a day devoted to celebrating colonialism. Ben Norton recently summarized the double standard of powerful nations in Salon (“This is why they hate us”). Western governments will make stirring speeches about freedom and democracy at home, then hope no one notices when they prop up appalling dictators, fund terrorists and destroy democratically elected governments overseas. As president Franklin D. Roosevelt’s is alleged to have said about the brutal Nicaraguan dictator Anastasio Somoza: “He may be a son of a bitch, but he’s our son of a bitch.” Along similar lines, American scholar Noam Chomsky's novel idea for how his nation could reduce the level of terrorism around the world was: “Stop participating in it.”

Yesterday the newly-elected Labour Party leader Jeremy Corbyn unveiled his shadow cabinet. Part of the line up was a position new to British politics: shadow “Minister for Mental Health.” Liverpool Wavertree Labour MP Luciana Berger, 34, assumes the role. She was first elected to Parliament in 2010, served as shadow Minister for Energy and Climate Change, and then shadow Minister for Public Health, campaigning for the NHS.

Regardless of where you or I stand on the political spectrum, this seems like an eminently sensible idea. Partly thanks to the efforts of former Deputy Prime Minister Nick Clegg in the last government, mental health issues have become a major political talking point lately and featured prominently in the election campaigns this past spring. But actions speak louder than cheap political rhetoric: over the last Parliament, mental health service budgets, already on their knees, were slashed by more than 8 percent. Services are inadequate. Last year, 7,000 vulnerable people in the U.K. with mental health problems—a lot of them children—ended up being held in police cells, because there were no beds available.

Freedom of information requests by Berger earlier this year showed that NHS clinical commissioning groups on average spend just 10 percent of their budget on mental health, which accounts for almost a quarter of the NHS’ burden of disease.

One in four people in the U.K. experience mental ill-health every year, causing an annual loss of £26bn to the economy.

Berger said: “Mental health should be treated no differently to physical health. People with mental illness shouldn't have to expect different standards of care simply because of where they live.”

In a speech in Parliament in February, Corbyn said: “All of us can go through depression; all of us can go through those experiences. Every single one of us in this Chamber knows people who have gone through it, and has visited people who have been in institutions and have fully recovered and gone back to work and continued their normal life.”

On Sunday, his first morning as leader, Corbyn snubbed the BBC’s Andrew Marr show and instead visited his local NHS mental health trust, Camden & Islington.

The ghost in the machine
One priority for any politician who wants to improve mental health services in the U.K. should be to promote a much greater diversity of available treatments. The NHS is far too therapeutically monocultural, wedded to the symptom-treatment medical model of clinical psychology, one that attempts to apply simplified, uniform labels to the vast diversity and complexity of human psychological distress, and a one-size-fits-all miracle cure-all in the shape of short-term cognitive-behavioural therapy (CBT). Psychotherapy and other more holistic and sophisticated approaches get squeezed out. Too often the notion of “stepped care” ends up being just one step—and not a very big one, either.

For more than two millennia, from the time of Socrates, psychology was essentially a philosophical endeavour. With the dawn of the Enlightenment, however, the Industrial Revolution, and a new age of reason which pledged its allegiance to rationality and logic, it abandoned its roots in favour of modernist ideas of “science.”

This shift was especially marked by the publication in 1913 of John B. Watson’s influential manifesto of radical behaviourism, which recognized “no dividing line between man and brute.” Watson was only concerned with the observable, measurable human responses to stimuli. What went on in between, in that messy “black box” of the human psyche, was of no concern. For the past century, this kind of “positivist” psychology that treats humans as machines has prevailed. It is still taught widely in universities. It directs much flawed, quantitative industry research that is influential yet of limited practical value to psychotherapists (the French existentialist Merleau-Ponty regarded the “science” of psychology as “always both naïve and at the same time dishonest”).

The new modernism is neuroscience. Brain scans are fascinating, but as explanations of minds, souls or consciousness, they are about as useful as a map of London is as an explanation of London. These neuroimages are but the flickering shadows on the walls of Plato’s Cave. They are fixated on the machine instead of the ghost in the machine.

At its best, psychotherapy dances with the ghost as well as the machine. It rejects attempts to delimit, confine or manualize the complicated business of being human and looks instead below the surface, considering historical causes of symptoms, unconscious and conscious motivations, intrapsychic and interpersonal conflicts, and environmental constraints and challenges. It embraces uncertainty (Voltaire: “Doubt is not a pleasant condition. But certainty is absurd”).

In a postmodern world, there are no absolute, objective truths when it comes to human beings and their psyches. Subjectivity rules, and my truth, my reality, my experience of being anxious, depressed, bipolar, schizophrenic, suicidal, disabled and so on might be entirely different to yours.