Peter Sheath on “Why it is the way it is…”

Posted on Posted in Administration, Treatment
Why?
Why?

Why it is that we’ve got the way we deal with human mental health so wrong

In discussing human mental health, I’m talking about a pretty broad church. I’m talking about all aspects of human mental health which I’m becoming increasingly convinced are intrinsically linked but we seem to be intent on making them separate. Starting in childhood, we allow the medical profession to diagnose our children with ADHD, ADD and, with increasing alacrity, things like bipolar and psychoses. Not stopping there they seem almost obsessionally committed to medicalising almost every aspect of the human condition including things like development, coping mechanisms and learning and we let them. Out of necessity they create more and more specialisms, associated experts and the pills and potions they are going to need to give people, in the main, just to prove the diagnosis put on them. A la, “He must be schizophrenic because he has responded to resperidone!” It’s pretty much the same across the whole thing, sometimes admittedly it may involve talking therapies but they are all too often delivered in a prescribed and manualised way as something done to people. Whole systems have evolved, all working in this way by treating people as if they are sick, disabled or have some kind disease. The problem being that when we are treated in this way, unless very careful measures are put in place to prevent it, we learn to become helpless and the system is a very good teacher.

Question: What Is Learned Helplessness?

Answer:

Learned helplessness occurs when an animal is repeatedly subjected to an aversive stimulus that it cannot escape. Eventually, the animal will stop trying to avoid the stimulus and behave as if it is utterly helpless to change the situation. Even when opportunities to escape are presented, this learned helplessness will prevent any action.

While the concept is strongly tied to animal psychology and behaviour, it can also apply to many situations involving human beings.

When people feel that they have no control over their situation, they may also begin to behave in a helpless manner. This inaction can lead people to overlook opportunities for relief or change.

The Discovery of Learned Helplessness: The concept of learned helplessness was discovered accidentally by psychologists Martin Seigleman and Steven F. Maier. They had initially observed helpless behaviour in dogs that were classically conditioned to expect an electrical shock after hearing a tone. Later, the dogs were placed in a shuttlebox that contained two chambers separated by a low barrier. The floor was electrified on one side, and not on the other. The dogs previously subjected to the classical conditioning made no attempts to escape, even though avoiding the shock simply involved jumping over a low barrier.

In order to investigate this phenomenon, the researchers then devised another experiment. In group one, the dogs were strapped into harnesses for a period of time and then released. The dogs in the second group were placed in the same harnesses, but were subjected to electrical shocks that could be avoided by pressing a panel with their noses.

The third group received the same shocks as those in group two, except that those in this group were not able to control the duration of the shock. For those dogs in the third group, the shocks seemed to be completely random and outside of their control.

Later, the dogs were placed in a shuttlebox. Dogs from the first and second group quickly learned that jumping the barrier eliminated the shock. Those from the third group, however, made no attempts to get away from the shocks. Due to their previous experience, they had developed a cognitive expectation that nothing they did would prevent or eliminate the shocks. (Seligman & Maier, 1967).

Learned Helpless in People: The impact of learned helplessness has been demonstrated in a number of different animal species, but its effects can also be seen in people. Consider one often-used example: A child who performs poorly on math tests and assignments will quickly begin to feel that nothing he does will have any effect on his math performance. When later faced with any type of math-related task, he may experience a sense of helplessness.

Learned helplessness has also been associated with several different psychological disorders. Depression, anxiety, phobias, shyness and loneliness can all be exacerbated by learned helplessness. For example, a woman who feels shy in social situations may eventually begin to feel that there is nothing she can do to overcome her symptoms. This sense that her symptoms are out of her direct control may lead her to stop trying to engage herself in social situations, thus making her shyness even more pronounced.

As I’ve mentioned before, things like shyness, loneliness, depression, anxiety, phobias and addictions are becoming increasingly looked at as biomedical conditions. A quick look in the DSM VI (the Diagnostic and Statistical Manual of Mental disorders) and you will find all of these, nicely psych speak labelled as things like social phobia, substance induced anxiety disorder, etc. no one seems to bat an eye lid because, hey, it’s the doctor’s call and doc knows best. And after all we’ve got a robust evidence base to support our decision making and inform the treatment package we decide to prescribe. If and when it doesn’t work, yes we’ve even got a label for that, it’s “atypical, non-responsive, sub symptomatic or, the best one of all, borderline.” Then when they ultimately reach the point of not having a clue they’ve got the whole rich spectrum of personality disorders to milk.

This whole thing serves to disable, disempower, disenfranchise and cannot help but give a sense that the person’s so called “symptoms” are out of their direct control and will almost inevitably stop them trying to engage with the social situations that are probably going to help them recover. It actually brain washes people into the belief that they are sick and, in many ways helpless or even cannot possibly be trusted to manage their own life. As they engage with the system, it takes more and more away from them. Assessments are very medically oriented, designed to find out what’s wrong so that the system can then tell you what they need to do to you to put it right. Congratulations and welcome to victimship, and boy have we got some drama triangles for you to involve yourself with! For a start we’ll make sure you’re paired up with someone with a pathological need to rescue you, then we’ll punish any indication of self efficacy or responsibility taking.

The underlying problem here is that we have developed a serious intolerance of the uncertainty of mental health. We desperately want certainty and the best way of deluding ourselves that we are achieving this is to medicalise it. If we bung it into a conceptual box, slap a label on it, the uncertain moves towards a position of certitude then all we need do is design something to wrap round it to keep it so. It gives us the illusion that we are in control, so what if by doing so we are actually teaching people to be helpless passive receivers of what we do to them? When something goes wrong, which it does with remarkable frequency, we create yet another set of drama triangles blaming “the patient” for not taking the treatment or the latest overworked rescuer for not having a risk assessment in place. No one ever looks at the system, the culture it creates, the lives being ruined and the further away it takes us from where we should be. It has to be right, doesn’t it?

Peter Sheath will be presenting these ideas alongside Peter McDermott and Mark Gilman on Tuesday 1st Sep 9.30-5.15 The 7th UKRF Community Gathering, Manchester http://www.ukrf.org.uk/index.php/community-gatherings/2015

2 thoughts on “Peter Sheath on “Why it is the way it is…”

  1. After 20 yrs in community mental health – i couldnt agree more – in fact it sounds like what i say day in day out – and the main reason why i moved to work in ABCD instead!

  2. It is so refreshing to read your views. I have been saying this for years – the need among professionals to medicalise life problems. Many people I have worked with over the past 30 years who are ‘unhappy’ with their lives have every right to feel unhappy whether that relates to the consequences of disadvantaged lives and lack of opportunity, broken relationships, experiences of abuse or neglect; or impact of bereavement.

    Whilst I am not saying that there isn’t a need for help in overcoming physiological dependency I do think that long term recovery is dependent on preventing ‘learned helplessness’ and capitalising on the ‘hope’ many people have for their recovery by providing them with the life skills and tools to achieve what they want, which isn’t always consistent with what the therapist wants.
    Finally, we have to remember that recovery belongs to the individual, not the array of professionals and pseudo-professionals that populate the Recovery Industry.
    Good luck with this and best wishes to Mark.

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