Global Health Asia-Pacific July 2020 July 2020 | Page 54

Cover Story
failed to come off drugs if her family hadn’t provided
for her during the process because she would have
probably ended up jobless and homeless.
This shows that socio-economic factors can
influence the ability to ad�ust to psychological distress
to a great degree, further blurring the line between
mild problems that self-correct and severe ones that
are thought to respond only to medications.
Socio-economic factors can influece the ability to adjust to psychological distress
To address the
overreliance
on drugs, Dr
Frances believes
that diagnostic
criteria should
be tightened
while doctors
should have
more time to get
to know their
patients
To address the overreliance on drugs, Dr Frances
believes that diagnostic criteria should be tightened
while doctors should have more time to get to know
their patients. “The diagnosis of depression should
take not just one session, but normally weeks, and
sometimes even months,” he told CNN.
At the same time, the public should value nonpharmacological
approaches and see drugs as a
last resort. “I think that the overwhelming clinical
experience and research finding is that most
people with transient, mild depression will do very
well on their own, and people should trust to their
own resources, get support from their family, get
psychotherapy way before they consider medication,”
he said.
In his view, antidepressants are more appropriate
for people with �real psychiatric disorder� � a label he
uses to describe severe psychological problems that
are not as self-correcting as milder ones.
But this approach can also have drawbacks since
severe distress lacks clear-cut biological causes like
mild depression and doesn’t necessarily improve with
medications, as �aura’s experience testifies, though
on average antidepressants do appear to be more
effective in severe cases of depression.
While struggling to go off medications, �aura spent
long periods of time on the couch, watching TV or
doing jigsaw puzzles, she told The New Yorker. Only
after six months of tapering did she manage to start
doing some part-time work. She said she might have
An alternative model
A key takeaway from the current pandemic and the
swathes of evidence showing strong links between
poverty and psychological suffering is that financial
support is needed as a main tool for helping people
with mental distress.
�Our government has done a lot in giving financial
support to people who are not earning. They’ve thrown
billions of pounds at it, it’s quite extraordinary. But the
message is that this redistribution of wealth needs to
continue because we need to live in a fairer society if
we want to reduce the prevalence of distress,” said Dr
Johnstone, noting that past austerity measures from
UK governments have fuelled poverty along with a rise
in psychological problems.
In addition to financial support, the dominant
medical model should be complemented with
alternatives for people who are uncomfortable with
being labelled as mentally ill.
One non-medicalising option is formulation, a
way of summarising people’s difficulties and the
possible reasons for them, which is widely used by
psychologists and other mental health professionals
in the UK.
This strategy avoids framing distress as a medical
illness or brain disorder and focuses instead on
individual life stories. While therapists draw on
research and clinical knowledge, sufferers bring their
own experiences to the table in order to create a
“shared story, a personal hypothesis” to make sense
of their suffering within the context of their lives,
explained Dr Johnstone.
In the case of a woman who feels the need to
constantly clean her hands, for example, formulation
could trace her distress back to the abusive
relationship with her partner and frame it as a way to
gain back control over her life.
Research, in fact, shows some people who have
gone through abusive relationships keep feeling
scared and out of control even after ending the
relationship.
In this hypothetical situation, “the formulation might
suggest that cleaning was one of the ways for her
to feel safe because the world feels very unsafe and
maybe it’s something she got used to do while living
with her husband because he didn’t hit her when the
house was clean,” said Dr Johnstone.
This type of narrative sets the stage for a way to get
her repetitive behaviour under control: For example,
she might need to talk through her painful memories of
52 JULY 2020 GlobalHealthAndTravel.com