Changing the lens on mental health (and detecting yet more opposition to Brexit)
Posted on 21 November 2017 | 10:11am
Last night I was at Reading University, delivering the Peter Campbell Lecture – no relation – in honour of the founding head of the University’s Department of Politics and International Relations. I was allowed to talk about anything I wanted, and decided to speak about the need for a new approach to, and new thinking about, mental health. The full speech is posted below.
First though, I had a session with politics students, a handful of whom were pro-Brexit, the majority however a mix of depressed about it, and determined to do something to help stop it. Then into the main event, where I did my usual ask for a show of hands in answer to these four questions
- optimistic or pessimistic about Trump? (99 percent pessimistic -two hands raised for optimism)
- optimistic or pessimistic about Brexit? (around 80-85 percent pessimistic)
- will Theresa May stand at the next election? (I think I saw two hands raised again -different ones to the Trump optimists)
- will Jeremy Corbyn be Prime Minister after the election? (about 10percent)
This all came as no surprise to me, as it broadly reflects virtually every audience I do these days, whether I am there to speak about Brexit or not, and it reflects a crisis in leadership home and abroad. In the q and a afterwards, the fears, anxieties and anger about Brexit came through loud and clear. But the show of hands seemed to surprise the audience. Perhaps that is because both main parties and the media keep saying there is no way out of this mess. As I said though, there is, if people keep fighting for it.
Enough of Brexit for now … here is the speech I made on mental health. Readers of WINNERS may recognise some of the sports bits. I hope it is of interest.
— I talk a lot about mental health; mainly from the perspective of the need to change the way we think about mental illness, to eradicate discrimination, to end the inequality of access, which means only fifteen percent of those who would benefit from talking therapy get it; to deliver on the maximum waiting times which exist in theory but are not met, and yet few shout and scream in the way we do about cancer or A and E services; to end disincentives in the system which mean mental health is the service most likely to be cut; to make the words in the NHS Constitution – parity between physical and mental health – actually mean something; to stop people being shunted around the country for treatment; to stop mentally ill kids being locked up in police cells, to accept that prisons are filled with people who should be in hospital not jail; to ask ourselves why mental illness is something of a research desert compared with physical illness; to urge the government to invest more in mental health today as a way of saving money tomorrow — so … quite enough to be going on with, for the Time to Change campaign of which I am ambassador.
I talk too about the issue from a personal perspective, my own issues of depression, drink and psychosis; and especially the inspiration of my brother Donald, who died last year aged 62, bang on cue given my Dad died aged 82, as a lifetime of anti psychotics takes around 20 years off your life. Imagine if drugs for diabetes or asthma did that. It would not be tolerated. Yet for people with schizophrenia, these drugs are the necessary but cruel, harsh reality.
That fight goes on. But today I want to come at this from a different angle … not just to speak up for the mentally ill as people who need support; but to speak up for the mentally ill as, often, major contributors to our life and times, and indeed to our history. To celebrate abnormality and thus specialness.
In the campaign world, we use the figure one in four – one in four of us will have some kind of mental illness at some point in our life. It is a useful tactical tool. But actually, if we are talking about mental health, one in one of us has that. We are all on a spectrum of good days and bad days.
Hands up anyone who has never needed to see a doctor for a physical illness? Ok … hands up anyone who has never needed to visit a hospital?
So physical illness is universal. And yet, though the mind is more complex than the body, we wander around assuming we are all perfectly strong mentally, all of the time, never at risk of illness, never in need of help. It is, dare I say, collective madness to imagine this is so. Last year I presented a Royal College of Psychiatry lifetime achievement award to Professor Peter Tyrer, who specializes in the treatment of personality disorders. In his acceptance speech he said ‘we all have a bit of personality disorder.’
I am certainly among the ‘one in four.’ I am a depressive, albeit to give you the title of one of my thirteen books, – writing is part of my therapy – a Happy Depressive.
I am also among the number who has been hospitalized for mental illness, back in 1986, after a psychotic breakdown which was the worst period of my life in many ways, but which I now look back on as the best thing that ever happened to me.
The worst because it was scary as hell, the mind cracking into thousands of pieces so that I was hearing voices, hearing music, and I convinced myself I was being tested by some unknown power, I was failing the test and the punishment for this failure was death. You can see I am still alive, so I was clearly wrong; but that fear was real, intense, made me behave even more oddly than usual. So I was arrested for my own safety, locked up, released on condition I went to hospital, where a few days later a friendly psychiatrist named Dr Ernest Bennie – to whom I dedicated my first novel, about a psychiatrist who went off the rails! – slowly led me to the realisation that I had depressive tendencies which I had for years been drowning in alcohol.
So why do I now say it was the best thing that happened to me? Because I learned from it. I stopped drinking, didn’t touch it for 13 years, and even when I fell off the wagon got back on fairly quickly. I learned also who and what were important. I sorted myself out. Got my career back on track. My partner Fiona stuck by me, when many wouldn’t. A year later the first of our three children was born.
Life was good. Then having done what I thought was the hard bit, the depressions started to come back. They still do. But I am stronger. I am more resilient. I have learned coping strategies, which include medication, sport, diet, my obsessive support for Burnley FC, and little psychological tricks known only to me and, sometimes if they are his idea, my shrink. And I am pleased if my openness helps others. But it helps me too, always has done, hopefully always will.
I have also been lucky. Much of the discrimination in mental health comes in the workplace, where bosses have an incredibly important role to play in breaking down the stigma and taboo. So here is the luck. My former boss, Richard Stott, who had been angry when I left the Mirror to join Today, was one of the first people to call me … ‘I hear you’ve gone mad …’ well, I am not well for sure … ‘well, I won’t say I told you so’ – a subtle way of saying I told you so … ‘but here is what you should do. Stay where you are for as long as you need to be there, take the money from Today, and when you’re fit, come back here.’
That was an act of friendship I will never forget. It showed, at a time I thought my career was over aged 28, that he was not going to define me through one period of illness. I would later become his political editor, and would be with him right up to the point when Tony Blair asked me to join his team, which I did with Richard’s support. Richard, alas now dead, would later also edit my diaries.
Tony was understanding as an employer too. When he asked me to work for him, I felt I owed it to him to talk him through the many things in my past that might become a media problem … drink, pornography, violence … When I told him of the music and the voices mid-breakdown, he did look a bit worried, but eventually he said ‘I’m not bothered if you’re not bothered.’ I said what if I am bothered? He said ‘I’m still not bothered.’
But one thing I know … if it had not been for my breakdown, I would not have been able to do the job I did for him, for as long as I did it, with the energy and commitment I had, nor take on all the things I do now. Why? Because I have a yardstick for pressure. I still get depressive episodes, would feel anxious and stressed, but I find a quiet space and say to myself, ‘if the breakdown was nine out of ten bad, how bad is this?’ and it rarely goes above four or five.
Also it has all taught me something that I now see as the single most important quality any of us can develop when engaged in difficult challenges – resilience. Politics is impossible without it. Ok, it is not nice when newspapers call you a liar, or compare you with Hitler, Goebbels or Rasputin – I had all those … it is not easy being the centre of firestorm upon firestorm, but you know what? It is not as bad as standing in the foyer of a council building in Hamilton, Scotland, with your head exploding, thinking you are about to be taken away and killed …
I was lucky with that moment too. It was the end of a long day that had started after a long night, which had ended with me having a row on the phone with Fiona because I was late and drunk again, so I checked into a hotel and emptied the mini bar. I had to fly to Scotland the next morning, pick up a hire car which I ended up dumping when I realized, after going round and round a roundabout dozens of times, that I was unfit to drive. A few hours later, as the voices crowd in on me in the foyer of a public building, I feel the need to call home. I am shown to a phone in an office and call Fiona. No reply. Call my parents. No reply. Call the number of any friend whose number I can remember. No reply. Later I learn I should have dialed 9 for an outside line. Every time I press 0, I am calling an unmanned switchboard. Back to the foyer. I empty my pockets. I empty my bag. I talk to anyone who passes, convinced they are talking to or about me. Then two men approach. My height. Quite unusual.
‘Are you OK?’ says one.
‘You know, I don’t think I am.’
‘Do you think you should come with us?’ says the other.
They could have been the moonies, but I said yes, and later I realize this was the first time I admitted I was not well. They are police officers, and next thing I know I am in a police car, then a cell, taking off my clothes and trying to wreck the place. But here is the luck, and I still have dreams about this … imagine if I had reacted not with acquiescence but violence. It could easily have happened. Today more than ever the police are the frontline of mental health.
I am not recommending psychotic breakdowns for all. But I am saying that sometimes it is too simplistic to think of mental illness only in terms of suffering and pain. Mine made me what I am. I am proud to talk about it, because I am proud that I learned from it, and use it to this day. Get Good Out of Bad, one of my rules of life.
I wrote a book called WINNERS, and one of my favourite quotes in it is from an Irishman, Colm O’Connell, who coaches Kenyan athletes, and says ‘the winner is the loser who evaluates defeat properly.’
A big part of winning is about the mind; mental strength, determination, the ability to respond in the right way to failure, the ability to handle pressure. And the ability to get good from bad.
When Michael Jordan was inducted into the Basketball Hall of Fame, he thanked players picked ahead of him, coaches who didn’t select him, journalists who had criticised him, for fuelling the fire of his ambition. And if anything sums up why Jordan is among the greatest winning mindsets ever, it is his final comment that ‘limits, like fears, are often just an illusion’. This is an extreme mindset, an abnormal way of thinking. Yet abnormality of thinking is too often what leads people to say of others – he’s mad, she’s bonkers, what a nutter … thinks he can fly to the moon. And then, guess what, someone flies to the moon.
I remember when Bono and Bob Geldof were lobbying Tony Blair before a summit in Germany, and Tony was warning them he couldn’t deliver all they wanted regarding the writing off of Third World debt. Geldof went into one of his customary effing and blinding rages. Tony tried to calm him, by saying we would get there but because of all the different agendas of the G8 countries, it felt like we were looking at Everest; to which Bono replied: ‘When you see Everest, Tony, you don’t look at it, you fucking climb it.’
Clive Woodward is the only English coach to have won the rugby world cup. Ask him to name his single most important quality, he says ‘I am an obsessive. I pride myself on it. It’s a good trait. It’s not something you should be worried about. Obsession is not about sending emails after midnight and trying to prove how hard you work; obsession is just obsession for the detail of the what, the how and the why you’ve got to do all the things you need to do to win.’
Of course it can go too far. When I left Downing Street in 2003, I did a series on great sportsmen and women for The Times. That was when I first met Lance Armstrong. I freely confess that I fell totally for the legend. I believed his protestations that he was the most drugs-tested athlete on the planet, had never tested positive, and it was time his critics let go. And I loved his mindset, summed up in what was without doubt the best single quote of the whole series
When I was sick, I didn’t want to die. When I race, I don’t want to lose. Dying and losing – it’s the same thing.
Knowing what we know now, the logic is obvious, and the former journalist in me should have been more alert to it: if you equate losing a race with losing your life, then just as most people would do anything to stay alive, so in his case he would do anything to win, including cheating.
Today, I can only cringe when I read his quote that his cancer ‘caused me to be a brutally open and honest person’. His is a story of what can happen when the desire to win goes beyond any legal or moral limit.
But just because obsessiveness can become destructive doesn’t mean that anyone with what I suppose one could term an ‘extreme’ mind should automatically be regarded with suspicion. In fact, the opposite is often true.
One of the most telling things I have heard about the mindset of winners is a remark made to me by Billy Beane, the man who transformed Oakland A’s baseball team with data-driven analysis which became famed throughout sport and beyond as Moneyball. ‘The reason all really successful people have to be slightly mad,’ he said, ‘is because people like that are not capable of living in the comfort zone. It is a state of mind that makes sure you never rest on your laurels, always focus on the next thing, never ever let yourself slide into that comfort zone.’
Now ‘mad’ is not a term that should be readily bandied about, but I do think Beane is on to something here. The fact is that people who want to succeed, to push things that bit further, tend to have characteristics that place them beyond what is generally defined as ‘normal’.
To me the most dreaded place on earth is ‘the comfort zone.’ My least favourite word ‘content.’ My mother was a content kind of person. Nothing wrong with that. It was all she ever wanted, to be happy in her life, to care for her family and for others. She would often ask me, why do you put yourself under so much pressure? The answer is, and she would shake her head as I said so, that pressure can create physical, emotional and psychological change which can help focus and sharpen the mind, give greater energy to the body, and improve performance at whatever it is you are trying to do. ‘You’re absolutely barmy,’ she would say. Indeed.
But the dangers of avoiding pressure are there for anyone to see: complacency and stagnation. Garry Kasparov, the world’s greatest chess player, came crashing down when he lost his world title to Vladimir Kramnik in London in 2000. As he explained to me: ‘I was at a very high peak and felt invincible. Not only did this make me complacent, but it also meant I had ceased to grow in areas that I did not require to win. I was crushing the competition, so why worry? This is why you must always challenge yourself with doing new things, leaving your comfort zone.’
So it’s a delicate balancing act. Pressure good. Stress bad. Balance difficult.
When King Lear was on at the national theatre a couple of years ago, I did a talk there on power and madness with Nassir Ghaemi, professor of psychiatry at Tufts Medical Center in Boston. He says that ‘normal’ people are naturally conformist. They go through education and career paths in which the goal is often to be liked and to achieve according to the norms of a previous generation, parents who want to keep them safe and secure, teachers who want to get them through standard exams. Ghaemi believes this ‘normality’ obsession discourages the development of skills needed to win. Great achievement therefore requires something beyond normal.
The most ‘abnormal’ period of my life was the build up to and the event of my breakdown, and I think it prepared me for the abnormality of a life in the political and government frontline. It didn’t change who I was but changed the way I thought about it and applied it to life; the fact that the mental torture of depression allows you to appreciate good times more; and that the mania that sometimes comes before and after a depressive episode can produce great bursts of activity and creativity. To repeat – I am not recommending psychosis, nor willing the horror of depression upon anyone. But I am saying that characteristics we would associate with mental health ‘problems’ might also be the engines that help one to overcome, to succeed, to win.
Professor Ghaemi, for example, argues that innovation and creativity are ‘explicitly a reflection of mania’. He suggests there are four main features of mania: increased rapid thought, increased physical and mental activity, increased likelihood of taking risk, increased confidence and self-esteem. When taken to excess, as I know, those characteristics can be dangerous, potentially deathly. But there can be enormous advantages in those characteristics when the mania is more or less under control. As my friend and colleague Philip Gould pointed out, I did some of my best work for Tony Blair when going through a manic phase, and others when in the throes of what he called ‘the glums’. I wrote the first draft of my third novel, about a teenage alcoholic girl, after cogitating and getting writer’s block over a year or so, in nine days. One of them was Christmas Day. I couldn’t stop once the creative dam broke. That was mild mania making me more creative than usual. By definition, increased rapid thought and increased physical and mental activity enable you to work harder, get more done, so provided the work is good and the decisions being made are the right ones, this should in theory lead to more success and achievement.
Additionally, no innovation happens without a degree of jeopardy. When I ask cycling genius Dave Brailsford which other walk of life he has learned most from, he doesn’t hesitate in his answer. ‘Psychiatry – no doubt about it.’ He describes his hiring of psychiatrist Dr Steve Peters as ‘maybe my most important single act of innovation – definitely innovation, not marginal gains.’ He also said this – ‘There is definitely a link between hyper achievement, and being a slightly or even seriously unbalanced personality.’
When Brailsford came across him, Peters was dealing with psychopathic personalities at Rampton high-security psychiatric hospital. ‘I realised that a lot of the things he knew applied to our riders. I’m not saying they’re psychopaths, but what makes them special is that their minds don’t work in the same way as most people’s. They are extreme. Extreme ambition. Extreme talent. Extreme drive and ego. But there are risks with that too, risks to them as individuals, and risks to the team. They can be strong but they are also vulnerable, and Steve was brilliant at making the strong side stronger and the vulnerable side less vulnerable.’
To move from sport to politics, who is the greatest historical figure of our lifetime? Trump would no doubt say Trump. Many more will say Mandela. For much of his life he was a labeled an extremist. He certainly had an extreme mindset. Is it ‘normal’ to be able to endure 27 years in jail and come out smiling and full of forgiveness? Is it normal to be able to cope with the torture of knowing you may never see your family and they are being abused and hounded?
Who was the Mandela of my parents’ and grandparents’ generation? – Winston Churchill; who is the American president all American contenders feel they have to laud as the greatest ever? Abraham Lincoln. Both were depressives – in Churchill’s case, of the manic variety.
Charles Darwin, Florence Nightingale and Marie Curie. All had what doctors today would define as some form of mental illness. Imagine a world in which those five had never been able to fulfil their potential because their mental frailties had been viewed as overwhelming obstacles. It would be a very different place. They were all major change-makers, their influence still with us today. Florence Nightingale, for example, single- handedly reinvented the basic concept of health care as well as challenging the idea that women could not be medical professionals. But she had a personality that today would be described as bipolar.
Ghaemi believes there is a strong link between depression and realism, which can contribute to leadership skills required in times of challenge and difficulty. This may in part be because depressives have experienced such lows that they can envisage many different – often bad – outcomes and this ability perhaps allows them to lead well in a crisis, or to have better strategies for avoiding it. ‘The thing about crisis is that the depressive imagines the worst and works to avoid it,’ he says. ‘The optimist believes they can handle the crisis and that everything will turn out fine.’ When Prime Minister Neville Chamberlain was pursuing a policy of appeasement, Churchill was constantly warning him about the danger of Hitler and the need for a stronger riposte. Indeed, his first public warning about the possible threat posed by German rearmament was in 1930, when Ramsay MacDonald was prime minister. Then in March 1934 he told Parliament: ‘Germany is arming fast, and no one is going to stop her. I dread the day when the means of threatening the heart of the British Empire should pass into the hands of the present rulers of Germany . . . I dread that day, but it is not, perhaps, far distant.’ It was a steady message through the premierships of MacDonald, Stanley Baldwin and Chamberlain. Were his depressive instincts making him more realistic about the threat that Germany posed, and Chamberlain’s optimism blinding him to reality? Ghaemi, for one, believes so. He said the same about Tony Blair and George Bush with regard to Iraq, but perhaps that is something that will come up in the q and a.
Depressives, though some may take their lives, tend to be more resilient too. ‘Melancholy seemed to drip from him as he walked,’ observed Lincoln’s law partner William Herndon of the President. But he said Lincoln had an inner strength, ‘as tough and gnarled as seasoned hickory wood, and the increasing hostility that his outspoken politics provoked as the country drifted into war, seemed to bounce off him like peas from a peashooter against a wall’. Resilience through depression.
Perhaps we can say that Martin Luther King became a great leader not despite being a manic-depressive, but because of it. The mania gave him energy and high self-esteem, which contributed to his charisma – important in any campaign leader – and forward-thinking – important in strategy. His depressive side outweighed his manic side and the qualities associated with depression – particularly understanding of human emotional pain – allowed him to be an exceptional and empathetic team leader.
It’s not unusual for anxiety to go hand in hand with creativity. Charles Darwin, born on the exact same day as Lincoln by the way, February 12 1809, had chronic panic attacks that often left him in floods of tears. In stressful situations he’d experience palpitations, skin inflammation, agoraphobia, blinding headaches and agonising stomach cramps. Over twenty-five years he consulted more than twenty doctors in a vain bid to find a cure. He visited spas and quack physicians. Darwin’s illnesses, however, accompanied a restless intellect that couldn’t accept the status quo and that was constantly asking ‘what if’.
The reason it’s important to understand all this is that a lot of stigma is still attached to anything that smacks of ‘abnormal’ mental activity. And that means that many organisations are missing out on having more potential winners in their midst. Sport is leading the way here, business and politics catching up. As part of the work with Time to Change, I speak to a lot of businesses, and I argue, that if you have two identical CVs in front of you, same A Levels, same degree, same kind of interests, both done the gap yah thing and the interning and volunteering, but one has six missing months, and they admit it was because they had a breakdown, were in rehab, whatever it might be … go for that one. Honesty, and resilience. Are these not qualities we are looking for in the people we hire?
Clearly the demands in sport are predominantly physical, and yet it is now seen as routine to have proper psychological and psychiatric support. In politics and business, by contrast, where the challenges are more mental than physical, no such attitude change has taken place. It’s a huge mistake, born of the fact that people all too easily feel threatened by those who are different. And it’s considered to be an admission of weakness ever to suggest that you yourself are suffering any kind of mental strain.
Yet the stress under which political and business leaders work – the hours, the sheer volume and nature of issues they are having to deal with, the shocks and setbacks that come with the turf, thetime spent separated from family – are all likely to have a negative psychological impact. It would be far better to acknowledge this and work with it, but most leaders just plough on. It is odd, that maybe 90–95 per cent of top athletes will have proper psychological support, but politicians who are operating under massive pressure think they can do without it.
Perhaps I should leave the last word on this to Sebastian Coe, someone who knows sport, politics and business from the inside. At the Moscow Olympics, a sports psychologist was advising him on how to create a ‘normal’ environment as he prepared to go for gold. The usually mild- mannered athlete was having none of it. ‘Do you think I’m normal? Do you think what I do is normal? Do you think running three times a day, a hundred miles a week, is normal? I don’t. Don’t tell me I’m normal. I’m not normal. There’s not a single person in this team who’s normal. We’re all fucking mad.’ A few days later, he won gold.
So there we are. I hope that has been of some use and of some interest. I hope it may have persuaded some of you to get involved in campaigning on this, because it is through campaigning that we can make change. And I hope one day we can look back and wonder – did we really used to accept medications that took 20 years off people’s lives? Did we really think the mentally ill were more likely to be violent than the general population when in truth they are more likely to be victims of violence? Did we really think it was OK to discriminate in the workplace on the grounds of someone admitting to a mental health problem?
One day we will have the parity between mental and physical health that today exists in the words of the NHS Constitution, but not in the practice of government or of the reality of healthcare. Only then will we be able to say we are a genuinely civilized country. Thank you