I’ve been thinking a lot about anger, and how we talk online about mental illness and its treatments.
This has been driven, at least in part, by the recent publication of a scientific review, by professor Joanna Moncrieff and colleagues, disproving the chemical imbalance theory of depression. Most clinicians and academics had already accepted that this theory is far too simplistic, so it didn’t come as much of a surprise. But then, on social media, fearsome arguments began. If the theory is wrong, how could antidepressant pills work?
Most doctors will agree that we don’t know how lots of medications work—try googling paracetamol and “mode of action,” and you will soon see that there is no easy explanation. But large randomised controlled trials have established that antidepressants can be helpful to patients, even if we don’t know exactly how. That’s not unusual: scientists often discover that something works and then look for the reason why afterwards; indeed, if you always worked from first principles, you would never get off the starting line.
However, some clinicians and patients have misinterpreted Moncrieff’s review as new evidence that antidepressants don’t work, perhaps as part of their wider arguments against the medicalisation
of mental distress. These views have been forcefully and emotionally expressed on social media, attracting an equally strong response from those who don’t agree with them.
What I find worrying is not actually the science around mental health—although that’s important—but why it ignites such anger. As someone with mental illness, who also treats it and writes about it, I have seen and experienced this anger at first hand, and I suspect that there is more to it than is immediately apparent.
When I was diagnosed with a serious mental illness, my first response was undiluted anger. I disliked and blamed the doctors who I felt had “done this to me.” I also felt a lot of disbelief and quite a lot of fear. “Why me?” I wondered, “what does this mean about who I am?”
So, I understand why people feel angry. Abstract debates about mental illness, its origins and treatments, can seem personal. And I wonder if their anger is more about fear—about the fear of what it means to be mentally ill, as I felt when I was first diagnosed.
At that time, I would have been a sitting duck for anyone who had tried to persuade me into conspiracy theories. In fact, I was halfway there already, without anyone trying. I didn’t think my doctors had my best interests at heart, and I focused almost entirely on the negative aspects of the treatments they gave me. My family had no knowledge of mental illness or psychiatry and believed my interpretation. This didn’t do me any good at all, as they believed me when I said I wasn’t ill, and then became angry with me and confused themselves when I couldn’t just get better.
I will always be frightened of mental illness, and of its treatments. Electroconvulsive therapy carries special fears for me, and I will never want to take drugs longterm. I understand that others can be frightened too, maybe in different ways, of the possibility of losing one’s mind—or of taking drugs that might dull the brain or swell the body. And I think that helps me understand why Moncrieff’s study provoked such a strong response.
But I also think—from personal and professional experience—that angry debates about mental illness are not helpful to anyone, least of all those who are living with it long term. Achieving progress in this complex area requires clinicians to build trusting relationships both with patients and each other, and to listen carefully to everyone’s views.
As the debate about antidepressants showed, you won’t find much of this collaborative behaviour on Twitter. I have learnt a lot and made great friends on the platform. But when the anger starts to upset me, I know I need to step away
