Feeling fine or feeling F.I.N.E?

Research out this month showed that the prescribing of antidepressants has reached yet another new record level. From 2021 to 2022 the number of prescriptions rose for the sixth successive year so that now roughly one in every seven adults in England have received antidepressants. Meanwhile Mind, the mental health charity challenged the UK Government and the NHS earlier this year on the 1.6 million people on the waiting list for treatment from mental health services. In fact, they claim another 8 million people can’t get on to a waiting list because they are not deemed unwell enough.

While scientists and researchers try to understand the drivers for the increases with questions such as whether we have a sick society, or the awareness of emotional struggle is reducing stigma about seeking help, or the impact of increased availability of pharmacological options or a combination of all these we have to keep in mind that one of the things we know all too well is that when patterns of worsening psychological struggle are left unattended the return to wellbeing is usually longer and harder. So, given the apparently worsening state of our mental health it is worth taking the time to pause and reflect.

So how are you and your loved ones doing?

A great place to start is with this very question. We are really used to asking this question, the problem is that it is often used as a greeting as opposed to an actual enquiry and then we are not always ready or equipped for the answer the question might bring. I’m sure we all have experience of answering or hearing ‘fine’ to this question where rather than the adverb meaning of ‘very well’ it might be more easily understood as an abbreviation such as Frustrated, Insecure, Neurotic, Exhausted.

Over the last year I’ve followed the campaign by the charity Time To Change where they encourage people to always ‘Ask twice’ as a way of getting past the first problem. Of course, what we also know is that whilst it is ‘good to talk’ that is only true if it turns out to be a good talk and they offer lots of helpful information on how to ensure your talk can be a good one.

But understanding why we or those around us may not be wanting to talk is also really valuable. When there is psychological pain, it is a natural response for the sufferer to want to avoid contact with others, to want to be left alone, often this is an attempt to avoid feeling overwhelmed by even more negative feelings, a response to where attempts to solve the underlying distress have previously failed and or resulted in an escalation of the pain. As therapists we know that talking about difficult things does not immediately bring relief, we also know that it is the way in which things are spoken about which is often crucial. We know for example, that with trauma there is always the potential for secondary trauma brought about by revisiting the initial trauma.

In therapy we understand that there are certain conditions that are needed for the causes of psychological pain to be understood in a way that can heal; we refer to these as the therapeutic frame. Emotional distress is a natural reaction to difficulties of living and often serves to keep us either safe and/or point the way to some kind of resolution. When we become stuck it means there is a dilemma that needs to be understood, that we are yet to reach the level of clarity about a situation that can enable us to become unstuck.

The nature of psychological distress is such that whilst it does point the way it can also make it extremely hard to think and reflect. Indeed, it can appear counterintuitive and initially feel more painful to slow down and focus but this initial experience can give way to something more hopeful and positive as the sufferer or listener expresses something that brings something new to the dilemma. As therapists when working with significant trauma we will pay close attention to levels of emotional distress and help patients to recognise and manage them when necessary.

Ultimately the best we can ever hope to achieve is to connect with suffering with intention of understanding so that solutions for getting unstuck can be uncovered. If the situation feels unmanageable then pay close attention to that and ask the question ‘what might be helpful?’ Remember every conversation provides an opportunity to understand and at the point it feels unhelpful then take a step back and think about what to do next. Sometimes taking a break is sufficient, sometimes changing the conversation helps and then there is always professional help.