When I am lying in my comfortable bed at night, I sometimes wonder what my life would have been like if I had been born, one hundred, five hundred, even one thousand years ago. And usually I breathe a sigh of relief that this is not the case, and turn over and go to sleep. But then I ask myself – why do I think things are the best they can be now? Maybe there were happier, more compassionate times in the past, or maybe life will become easier, even free of disease in the future. It is a strange assumption that this is the right time, matched only by the extraordinary chance that this is the time when we are living.
One of the things we face today is rising expectations which are not matched by our ability to meet them. We see ourselves as deserving, often of what we want rather than anything else. An easy example is when we reward ourselves after a hardish day’s work with some sort of treat. I deserved that glass of wine, or I owe it to myself. It’s quite absurd, but helps us to justify our decisions, which may not be altogether the ones we should make.
Rising expectations are seen in the arenas of mental health and mental illness, without the resources to meet them. I have no doubt that mental illness is real; in some people it will be biologically driven in the same way that other illness are, but with life’s experiences and trauma playing important roles. For many, trauma may be the main determinant. However the wide range of symptoms caused are divided into often quite artificial constructs, and then named as disorders. These have multiplied over the years, giving us a wider, and ever increasing range of options. This may or may not be a good thing, but if there are more diagnoses, there is increasing pressure to allocate them.
This would be less of a problem if we had equally expanding services, but many aspects are contracted, or they are simply unable to get staff. So an increasing proportion of the population are being told that they may have a mental illness that could be treated, which may be affecting their achievements and the quality of their lives, but are finding themselves on long waiting lists, even for assessment. Some may then benefit from treatment, but there is a chance that others won’t, and may then feel wronged, or even exploited, by the same services that said they were ill. There is also the knock-on effect that those with very severe mental illness, like schizophrenia, may be afforded less care, given the dilution of services. No-one wins.
Going back to the concept of whether we deserve things or not – do we deserve treatment? It’s a very loaded question, as it implies that there may be people who don’t. Or do we deserve it purely because we exist as humans, and if we do, then there are some very unfair things going on. But the sad fact is that the world is an unfair place, and some people live awful lives which no-one could say they deserve. There’s no reason why I deserve treatment any more than they do, but sadly I’m more likely to get it.
Most of us want the best for our communities and for other people, but, when it comes to it, we want it more for ourselves and our immediate families and friends. It would be asking a lot for us to wish otherwise. But does this mean we see ourselves as more deserving? Possibly not, but I think we are losing the meaning of the word, and it has become a combination of what we see as our rights, and also what we want, or yearn for.
In the past people had their places, and if you were a pauper you knew it, and your expectations were probably low. Things may be better now, with more hope for more people, but no-one could pretend that we are all born with the same chances. Mental illness can be a great leveller, but it is still more common where there is deprivation, and I have no doubt that access to treatment is less likely in such circumstances.
My concern is that as concepts and constructs of mental illness expand, then access to assessment and care will become even less fair – already, many who can, will pay, avoiding growing waiting lists. And as treatments become better and more sophisticated, how will it be possible for everyone to have equal access to them in a limited health service?
I am still glad to live in the age that I do, rather than past times. But realistically my knowledge is limited – I fear the chains of Bedlam, or the fate of being declared a witch – but perhaps history tends to remember what was dramatic. Few of our treatments for mental illness are very effective in terms of cure; but they can alleviate the symptoms, and this is an achievement of modern times. It would also be good if we were able to see where pockets of kindness existed over the years, and understand more about how people viewed mental illness. My guess is that this waxed and waned, varying between different cultures at different times.
Our modern view of mental illness is highly medicalised, with increasing numbers of disorders. If this is helpful to people, it may be positive, but it is hard to know, and may only be clear retrospectively. Will we look back with satisfaction, or with dismay or even horror? We can only try our best with what we have to hand, and it is worth remembering that past generations will usually have done the same, even if we think they got it wrong.
In the end, the most important thing is not to assume that we are right, or even that there is a ‘right’. I don’t know what we deserve, but I think it will always be changing.