One in six women and one in nine men must expect at some time during their lives to be patients in a psychiatric ward. Between 1972 and 1982 more than one million people in Britain will have sought psychiatric help, and many more in need of it will have suffered alone.
Of every £100 spent on the National Health Service, only £14 is allocated to mental health and mental handicap, even though over 40 per cent of all hospital beds are occupied by the mentally sick. In 1972, £65 a week was spent on people in hospital with “physical” disorders and less than £22 on mental patients; the proportions have not changed significantly since then. It is admitted that, with very few exceptions, mental hospitals are old, grim and, often in spite of tremendous efforts by medical and nursing staff, a totally unsuitable environment for the mentally sick. Psychiatric out-patients have doubled in the last ten years and attendance at psychiatric day hospitals has almost trebled in the same period. Nevertheless there is still an astounding ignorance and consequent (usually unadmitted) fear on the whole subject, and the use of phrases like “looney bin” and “lunatic asylum” is still common. Those with a known history of mental illness are approached with trepidation. In the United States a study by G. M. Crocetti (Contemporary Attitudes towards Mental Illness, 1974) showed that 71-93 per cent of those surveyed were prepared to work with colleagues who had been mentally ill; 79 per cent were willing to share accommodation; 64 per cent thought they could “fall in love” with someone with such a history, but only 30 per cent were prepared to accept such a person as a close relative. Although exact figures are not available, there are strong indications that refusal to accept people with a history of mental illness is often the cause of relapse or even suicide by men and women who cannot find a place in society after discharge from treatment.
Mental illness can take the form of neurosis, psychosis, hysteria, or (most common) different types of depression. Its principal cause is STRESS, which in some degree is necessary to lead a meaningful life; in modern capitalism, however, it quite often leads to acute anxiety and mental illness ending, too often, in attempted or successful suicide. David Ennals in his book Out of Mind lists twelve causes of stress in modem life:
" . . . overcrowding, pressure of traffic, noise, struggle against poverty, unemployment, homelessness, loneliness, rejection, inability to keep up with the increasing speed and competitiveness of modern life, the survival of the fittest and the most ruthless, the rush for money and power, the anonymity of life in large cities.”It would be difficult to better describe the problems besetting workers under capitalism, and he concludes: “Statistics about gross national product, productivity and material wealth have little to do with human happiness”.
A working class condition
Not surprisingly, poor environment greatly affects mental health. A recent study of British Service families in Germany in high rise flats showed that there was a greater incidence of mental illness the higher up they lived. A study in Bristol came up with the same results: one mother in three was attending her doctor or taking a prescription for a neurotic condition. However, almost identical figures came up in a study of working class terrace housing and work done by the Psychiatric Rehabilitation Association shows clearly the greater vulnerability to mental illness in lower income groups.
Mental illness causes more lost working days than accidents, industrial disease, colds or industrial disputes, yet the Committee on Safety and Health at Work (July 1972) completely ignored it. An examination of a sample of 2,000 men showed that 17 per cent had stress symptoms, Of these by far the highest percentage (65 per cent) was stress due to work.
Bernard Ineichen in Mental Illness (1974) quotes a leading investigator into connections between mental health and working class conditions:
“The unsatisfactory mental health of working people consists in no small measure of their dwarfed desires and deadened initiative, reduction of their goals, and restriction of their efforts to the point where life is relatively empty and only half meaningful . . . reduction of striving is at one and the same time an aspect of poor mental health and a safeguard against even worse mental health.”For many, repetitive, soul-destroying jobs are the only ones available, or are taken because of comparatively high wages. On the other hand, managerial jobs are demanding, mean long hours, fear of failure, nervous exhaustion and overwork. Again, unemployment and lack of money leads to loss of self-esteem in a system where people are usually judged by what they have rather than what they are.
The very high rates of suicide in the 1930s (115 per 100,000 of male population) were directly related to social, economic and industrial difficulties. There was an expected drop during the war, a return to higher figures immediately afterwards (95 per 100,000) and a considerable drop by 1972 (76 per 100,000). The figures for women varied less dramatically (from a peak of 50 per 100,000 in 1955, repeated in 1965, to about 40 per 100,000 in 1970—earlier figures are not available). Thus it can be seen that although the proportion of women who suffer from mental illness is one and a half times higher than men, the percentage who commit suicide is just over half. It is also surprising that the overall rate has so dramatically decreased in recent years even though economic and social conditions in many ways resemble those of the ’30s when the rate was highest.
These figures are not parallelled in any other country. In Japan there has been a drop from the previous very high rate, which social scientists attribute, at least in part, to the replacement of feudal duties (including Hari-Kiri if you let your lord down) by Western style capitalism. In Israel the rate fluctuates according to the state of hostilities, and the drop in Australia appears related to the statutory limitations on the prescription of barbiturates introduced in the 1960s. The introduction of “blister” packs—where each tablet must be individually handled—is a considerable deterrent to the impulsive over-doser. As about half of all suicides or attempted suicides are by self-poisoning this measure, even within the economics of capitalism, seems essential. Another impediment to suicide has been the introduction of natural gas which could still kill by asphyxiation or explosion, but very seldom does. (A sidelight on the American Constitution and the “right to carry arms”, as vehemently defended by the powerful gun lobby, is that in California over a third of all suicides are by firearms—a method which does not allow the ‘second chance' permitted by overdosing.)
The two social factors most clearly associated with the high suicide rate in the 1930s were social isolation and geographical mobility. The most typical suicides were middle-aged or elderly men living alone in bed-sitters, separated by many miles from their nearest relatives. This should be remembered by those who today speak blithely of “the mobility of labour” and the need for workers (other workers, never they themselves of course) to “go where the work is”. Suicide rates decrease at times of war, as does mental illness generally. During the 1969/70 riots in Belfast, suicides were halved. In spite of the danger, “being in it together” appears to give a sense of purpose loneliness and feeling apart and isolated have the opposite effect.
Attempted suicide should more properly be referred to as self-injury; probably only a minority of people who injure themselves deliberately intend to die. Self-injury has increased dramatically in post-war years, and particularly since 1960. About 19 of every 20 hospital admissions for self-injury today are due to drug overdoses; many of these are not intended as the final act, but are a cry for help. Suicidal attempts in the early 1960s were 30/40,000 a year, which increased to over 50,000 in the early 1970s. However actual deaths fell from 5,000 to 4,000, decreasing not only in actual numbers, but the “success” rate dropped from 17 per cent to 8 per cent.
Depressive illness accounts for at least two-thirds of all suicides. Emile Durkheim in his study of suicide at the end of the nineteenth century contrasted the life of French villagers in their close-knit communities with those who strayed into the industrial cities. The former inter-dependent community experienced a comforting sense of solidarity whereas the latter, surrounded by strangers, though free of the constraints and rules of their previous rural life, became isolated, alienated and depressed.
Suicide rate
The fall in the suicide rate in recent years has coincided with the growth of the Samaritans—an organisation of men and women who talk to people in deep personal distress. Between 1964 and 1974 their “clients” rose from 12,000 to 156,000 and the numbers are steadily rising.
Many suicidal people are at the end of their tether because they feel isolated, either physically or because they cannot communicate with those close to them. It is the alienation which is part of present day life which makes the “befriending” of the Samaritans so successful; talking to someone who “has no axe to grind” helps to dispel the isolation and despair felt by the man or woman contemplating suicide and makes them feel able to carry on living. Samaritans do not give advice or try to convert their “clients”, either religiously or politically.
There are counselling services in other countries, but they are usually run by paid “professionals” or are religion dominated. Counselling services offered in Sweden and Norway are firmly based in the Lutheran Church, whereas Stuttgart is not the only town in Germany where rival Protestant and Catholic telephone emergency services exist (referral across town if the potential suicide rings the wrong number?).
Until the end of the nineteenth century, our forebears put up with conditions, hardships and humiliation which we would consider unbearable; they did so because they saw no alternative. Today, surrounded by advertising, films and television programmes constantly reminding us how much better off others are, people feel cheated if their own standards do not reach such levels. Doctors, no less than dockers, have to accept that if they do not constantly strive to improve their working conditions, they will “fall behind”. Not only deprivation, but inability to “keep up with the Joneses” leads to neurosis and depression. To counteract this, drug companies have devoted their energies in the last twenty years to perfecting tranquillisers and anti-depressants. The trouble, of course, is that these ameliorate effects but do nothing to remove the cause. In London alone there are at least 11 voluntary organisations in addition to the Samaritans who try to help those in danger of “going under”.
Dr. Richard Fox, Consultant Psychiatrist at Severalls Hospital Stevenage, concluded his paper to the Royal Society of Health Conference in September 1974 by stating:
“Durkheim said in 1897 that the suicide rate of any society was an index of that society’s structure and the general quality of life in all its facets. The stability of suicide figures whatever methods are available supports that hypothesis. To prevent suicide, it follows you have somehow to try to change society and to change the quality of life.”
While Durkheim did not accept Marx’s social theory, he came closer to the solution than most doctors, psychiatrists and other well-meaning people who try to help those who despair to the point where they no longer wish to go on living.
Eva Goodman
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