Co-authored with Irene Sutcliffe – you can follow her on Twitter here
On 16 September, the Sunday Times published an interview with the leader of the Scottish Conservatives, Ruth Davidson. The piece was both about Davidson’s private and public lives (the two can’t really be separated, not in her line of work): her pregnancy and the importance to her and her partner of starting a family, her political career to date, and her desire not to be Prime Minister (despite strong rumours to the contrary). The interview was trying to be a refreshing take on a Conservative politician – as the interviewer points out, on the surface, Davidson is hardly your archetypal Tory, ‘…a working-class, winningly informal, cheerfully profane 39-year-old lesbian former kick boxer…’. The piece even begins with Ruth dancing for the photographer, apparently unembarrassed. She is portrayed as frank, amusing and charming. She has an autobiography coming out, called ‘Yes She Can’, and a lengthy extract from this book, which deals with her breakdown aged 17, is printed at the end of the interview.
It should only be a good thing when well-known figures, especially those in positions of political power, are candid about their mental health issues, for several reasons. Firstly, and perhaps most obviously, it shows that the black dog strikes indiscriminately – sure, Davidson is a lesbian from a working-class background, but she is also an educated cisgendered white woman who can’t fairly be called working-class these days. Secondly, it demonstrates that mental health difficulties needn’t be a barrier to doing such a demanding job. And thirdly, such people are actually in a position to change the way the state provides for those with mental illness – which it does woefully badly at the moment. Woefully badly.
We cannot emphasise this point enough. English NHS services are laughably understaffed (for example, when one of us was under section in a psychiatric unit in a hospital with 6+ wards, there was ONE doctor covering the whole hospital outside of 9-5 Monday to Friday hours). Waiting lists for NHS therapy are horrifically long, and even private therapists are stretched. The postcode lottery is a huge factor in terms of what is available to those suffering with mental health problems. While the NHS in Scotland is devolved (in fact, it has always been separate) and hasn’t had to cope with a drive towards marketisation, years of real terms cuts to the Scottish government’s budget and increasing demand mean that there is still huge pressure on resources, and services are certainly not where they should be. The recent allocation of additional resource to mental health care in the Scottish budget is a very welcome step, but will not go far enough in solving the problems. Stories of people not getting the care they need will continue to proliferate.
The interview proved points 1 and 2 pretty well, and there’s not much need to go into those here. But let’s take point 3. As an MSP, the leader of the second largest party at Holyrood and an aspirant to the position of First Minister (if not, as she claimed in her interview, that of Prime Minister), Davidson has a prominent platform from which to advocate for significant improvements in this system and – just as importantly – to will the means required to make such improvements happen. One of the most crucial things that mental health services require for improvement is, essentially, a huge injection of cash. But we also need meaningful changes in the way the state – and society – view mental illness in all its various forms: not as the fault of the individual, but as a difficult and unfair thing that could befall anyone. It’s also not the responsibility of the individual alone to recover from their unwellness: it’s society’s duty to help everyone, and to make necessary adaptations for those with mental health problems so that they can operate within society and not on its fringes.
So, what does Davidson have to say about all this? Here is the extract in full, with our commentary:
I went to university at 17 years old. If I’d known then that knowledge was not the same as intelligence and confidence no substitute for ability, I might not have struggled so much. But another event crashed into my world. A boy from my home village committed suicide. I’m not a psychologist and I don’t know why his death affected me as much as it did, but I went into a total tailspin.
I started hurting myself: punching walls, cutting my stomach and arms with blades or broken glass, drinking far, far too much and becoming belligerent and angry, pushing people away. I was punishing myself and hating myself for it at the same time.
So Ruth really was unwell, for whatever reasons – biological, psychological, social, whatever. She showed her interviewer the scars on her arms: One of us, too, has these scars. We know the urge to self-harm, to drink to make the noise in your head shut up, and an awful lot about existing as a ball of sheer anger. Despite the political and personal gulf between ourselves and Ruth, we share that in common. And it resonates.
At 18, I was diagnosed with clinical depression and put on antidepressants. I was frightened, confused and worried that I might be going mad — that this was what a mental breakdown was. After starting medication, I had desperate, dark, terrible dreams that were so vivid, I couldn’t tell what was real. I became anxious and paranoid. I started having suicidal thoughts. Every time I went back to the university health centre with a fresh set of injuries, the doctor on duty just doubled my dose and things got worse.
In the end, I was on the maximum dosage allowed and became so scared of sleep that, in my second year, I spent a whole term living nocturnally. I stayed up through the night and only went to bed once my flatmates had left for lectures. As an arts student with very little structured time — we were in charge of our own required reading and making sure essays were handed in — nobody much noticed or cared if classes were missed.
Here’s the thing. Antidepressants can cause mad, adverse side-effects that do often diminish with time. They can be really horrible. We ourselves, and plenty of people we know, have suffered side-effects that range from the unpleasant to the truly grim, and we have all had the experience of waiting and wondering if things will improve. We feel really bad for Ruth in this situation. Because it’s horrible, obviously. No-one wants to suffer this way. The problem here is that Ruth doesn’t seem to have been tried on any other types of antidepressant when whatever she was put on was having adverse effects, and doesn’t say whether or not she was offered any therapy. Really, those are the issues here, not antidepressants in themselves. It is easy to stay stuck on meds that don’t work for you if you’re depressed and not really in a place to argue with doctors. What might really have helped Ruth here is psychiatric monitoring, and pathways into therapy. Essentially, providing both those things boils down to money.
But then, things get tricky.
Intellectually, I know that drug therapy helps millions and that in a different time, or with a GP who knew me, instead of the revolving door of a university health centre, I could have received treatment that helped me get better, instead of making things worse: the manufacturer of the drug I was on has since paid out millions following class-action lawsuits after evidence of increased suicidal behaviour in adolescents.
Davidson doesn’t say which drug she was taking, but there have indeed been concerns about the risk of increased suicidal behaviour among young people taking SSRIs, and lawsuits have indeed been settled by manufacturers. Some drugs are no longer prescribed for children and young people because of such concerns, and practitioners are much more alert to the dangers. Serious side effects of this sort were and remain rare, however, and it doesn’t help anybody for a senior politician to make statements that could prove unnecessarily alarming.
But the key point here is actually not one Davidson meant to make. The experience she describes is of being prescribed a drug and then not receiving the consistent help and support she needed when it didn’t work for her. That is what happens to far too many people suffering mental ill health in this country. And it happens precisely because overstretched health care providers are not able to give people the time and attention they need, because the resources aren’t there to pay for them. So we come back to money, and the problem for Davidson here is that she has consistently supported the austerity policies of a UK Tory government since 2010 which have led to so much increased pressure on health services and devolved government budgets. And when the Scottish government increased income tax on the well off in order to address some of the budgetary shortfall, who led the charge against it? Why, of course, it was Ruth Davidson. She’s happy to will the end of better mental health care, but totally opposed to willing the means.
There’s only one way that Davidson can escape the implications of her statement, and that again comes down to what she can will – or thinks she can, at least.
I had mocked the leaflets I was given on the diagnosis — NHS instructions to do light activity, like housework or clearing out my cupboards. But eventually I made a decision to will myself better. I resolved to build a structure to my days and weeks, to set short- and medium-term goals, to engage in purposeful activity that had a measurable outcome, to take regular exercise, moderate my drinking, go back to church and be kinder to myself.
This is where the wheels really start to fall off in an alarming way. Firstly, you simply cannot will yourself better from depression. Fact is, Davidson structuring her days was a very good idea and probably took immense strength of character, but she did not will herself better. That is something we’re told to do when we’re unwell, which we can’t do, or fail to do, and end up beating ourselves up when going for a run or doing meditation or being somehow more mindful doesn’t work. This is where dogmatic Conservative ideology rides in to rescue Ruth from the real lesson of her story. Now she can assert that YOU have to get better ON YOUR OWN and it comes FROM YOU. Yes, there’s an element of truth to that, but it’s also, as we’ve said, something we do in collaboration and something for which we are collectively responsible as a society.
Most importantly to me, I threw away my pills and promised myself that, whatever happened, no matter if I slipped back, I would never take them again.
I couldn’t go back to a place where I didn’t know what was real and what wasn’t, where my emotions were hollowed out but my anxieties heightened.
Well, obviously those particular meds weren’t working for her. I think we’ve established that. But this is just the sort of ‘get on with it yourself with no support’ attitude that Tories standardly resort to and take pride in. It’s also worth noting that her diagnosis was depression. Thing is, not all mental health problems are the same. Schizophrenia, bipolar disorder and psychosis – these are things for which drug therapy is usually the norm, and inpatient stays are often necessary. Ruth’s bootstraps approach certainly wouldn’t do the trick here. All this, what’s more, in a society where both work and welfare are being re-engineered in ways that increase the chances of people – especially those without privilege or capital of any kind – getting ill.
And this inevitably colours her somewhat solipsistic account of where things are at now:
More than 20 years later, the ways in which we understand and respond to mental-health issues are unrecognisable from what they once were. The stigma is much reduced, and depression is something that far more people feel able to talk about. There’s a long way to go, but it helps when more people in more fields open up — when sports stars, royalty and business leaders say publicly that they have a condition they manage, and can demonstrate that it doesn’t stop them achieving.
I am still frightened of going back to the psychological place I once inhabited. When I have periods of heightened anxiety, or I can feel the weight of the black blanket start to descend, I go back to what I know works for me: structure, exercise, forward momentum, measurable outcomes.
Well, yes, openness is important, and great to see. But this is much too rosy a picture. Twenty years on, we don’t actually understand all that much more about the workings of the brain than we did. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is still an evolving document, and there is a huge debate underway about the usefulness of any diagnoses in mental health. We’re also not sure stigma is reduced – the fact we talk about it is one thing, but when we’re told to talk to someone about our mental health – who exactly do we talk to? Many Community Mental Health Teams are now not taking patients unless they have already attempted to commit suicide. That’s the criterion for getting help in some places – try and off yourself. And again, this is down to an already-underfunded mental health system in England being gutted by the Tory government to which Davidson offers her unwavering support. So it’s great that she has her techniques to stave off depression and they work for her, but the idea of pulling yourself up by the bootstraps and getting on with it when you are unwell is simply laughable. The vast majority of people involved in mental health care know this. While Davidson and her supporters comfort themselves with their self-affirming story of self-reliance, out in the real world more people will die.