An open letter to Stephen Fry on mental health

The clinical psychologist Richard Bentall has written an open letter to Stephen Fry on the BBC's In the Mind season. It was launched by a programme about Fry's own mental health problems.

Bentall writes:

Conventional psychiatry tends to decontextualise psychiatric disorders, seeing them as discrete brain conditions that are largely genetically determined and barely influenced by the slings and arrows of misfortune, and it was this perspective that was uniquely presented in your recent programme The not so secret life of a manic depressive ten years on. 

According to this ‘brain conditions’ view, psychiatric disorders occur largely out of the blue in individuals who are genetically vulnerable, and the only appropriate response is to find the right medication. Even then, it is usually assumed that severe mental illnesses are life long conditions that can only be managed by continuous treatment. 

However, research into severe mental illness conducted over the last twenty years (not only by me, although I have contributed) tells a more complex story.

He goes on:

Of course genes play a role in making some people more vulnerable to psychiatric disorder than others, but the latest research in molecular genetics challenges simplistic assumptions about ‘schizophrenia’ and ‘bipolar disorder’ being primarily genetic conditions. 

The genetic risk appears to be shared across a wide range of diagnostic groupings – the same genes are involved when people are diagnosed with schizophrenia, bipolar disorder, ADHD and even, in some cases, autism. 

More importantly, genetic risk is widely distributed in the population with hundreds, possibly thousands of genes involved, each conferring a tiny increase in risk.

By contrast:

Recent epidemiological studies have pointed to a wide range of social and environmental factors that increase the risk of mental ill health, some of which I am guessing you may be familiar with from personal experience. 

These include poverty in childhood and early exposure to urban environments; migration and belonging to an ethnic minority (probably not problems encountered by most public school boys in the early 1970s) but also early separation from parents; childhood sexual, physical and emotional abuse; and bullying in schools. In each of these cases, the evidence of link with future psychiatric disorder is very strong indeed – at least as strong as the genetic evidence ...

And of course, there are a myriad of adult adversities that also contribute to mental ill health (debt, unhappy marriages, excessively demanding work environments and the threat of unemployment, to name but a few). Arguably, the biggest cause of human misery is miserable relationships with other people, conducted in miserable circumstances.

I have seen other psychologists making the same criticism of programmes in the In the Mind season.

If you want to know more about Richard Bentall's research you can watch a video I posted here in 2013.

He also gave an engaging interview to The Psychologist a couple of years before that.