Scene from The Sopranos in which Tony Soprano talks to his therapist Jennifer Melfi
Image: The Sopranos © HBO

Talking about mental health is embarrassing, expensive, and difficult. This has got to change

After recently starting therapy, Joe Earle talks about tackling the pressures that stop us from being more open about ourselves

I started therapy about two months ago. Every week I spend 50 minutes talking about everything from my work that day, to my relationships, my childhood, and my hopes and fears for the future. My therapist listens and asks me questions or makes comments when my flow runs dry.

Last week I bumped into a friend on the way to my weekly session. He asked what I was doing and with hesitation I told him. His face screwed up and he reached out to put his hand on my shoulder. “You alright mate?”

“Yeah, I’m fine,” I leapt in. “There’s nothing wrong with me. I just want to get better at expressing my feelings.” He looked unconvinced and told me that he was always there if I needed anything. As we parted ways I felt deeply uneasy but couldn’t work out why.

Looking back I realise I was embarrassed to be talking about my therapy. I was frustrated that he assumed that I was depressed and needed help. At the same time, I felt ashamed by how quickly I’d distanced myself from being ‘ill’, as if that was something to be ashamed of.

I believe we should redouble our efforts to make therapy available for everyone irrespective of our health or background. We need to recognise its broader value in helping us live a good life, however we choose to define it. But social pressures, high costs, and a polarised understanding of what being 'mentally healthy' looks like puts people off. I don't think that's right.

We've got to understand mental health in a less polarised way. At the moment, we seem to think that there are people are either ‘well’, ‘fine’, and 'mentally healthy'; or are ‘ill’ and diagnosed with clearly labelled 'disorders' like anxiety, depression or obsessive-compulsive disorder.

We need to understand mental health in a less polarised way.

I don’t fit into the ‘well/unwell’ boxes. I consider my mental health to be OK. I filled in a form at the start of my therapy assessing my wellbeing - like how often I felt stressed and how often I struggle to sleep - and all of my answers were 'rarely' or 'never'. But I signed up because I felt that I never really reflect on, or share with others, what’s going on inside of me. I’m very good at talking about other people’s feelings but not my own. And when shit hits the fan, as it does at some point in everyone’s life, not being able to engage with people around us on an emotional level reinforces isolation and helplessness and makes everything harder. If more people had therapy when they felt great I believe they’d be better prepared for when they didn’t. Therapy is about reflecting upon, understanding and articulating our inner life and what it means to be human.

Economic and social pressures stop people from being able to access therapy as easily as I think they should. On a very basic level there’s the cost. Mine is done on a sliding scale according to how much you earn and costs £35 a week. It is a very real barrier to more people having therapy as a routine part of daily life.

Governments can’t afford the kind of therapy I receive on a national scale. If you go to a GP and are referred to therapy, you’re most likely to be offered Cognitive Behavioural Therapy (CBT), which focuses on changing how you think and behave. It’s popular with health policymakers partly because it’s generally shorter and can be delivered by a computer programme and is therefore cheaper than other therapy. In contrast psychodynamic therapy (which I am doing) is one on one and open ended which in a publicly funded service might feel like writing a blank cheque. In this context calls for a universal system of publicly funded therapy seem utopian; but the cost of private therapy isn’t likely to encourage people to give it a chance.

This is where tough economic realities grind up against grand ideas. Most research so far focuses on the economic cost of mental illness. For example, in 2014 the Organisation for Economic Co-operation and Development (OECD), a prominent international economic institution, highlighted that mental health issues cost the UK around £70 billion every year -roughly 4.5 per cent of GDP - in lost productivity at work, benefit payments and health care expenditure. But I’m arguing that therapy should be encouraged for everyone whether or not they are deemed to be “ill” – and here the economic benefits are much harder to measure. If therapy does help people build stronger, healthier relationships then it might make workplaces more productive but that relationship would be hard to capture.

Is weighing up economic costs and benefits even the right way to decide how much public money to spend on therapy? It may be that the economic cost of making therapy universally accessible whether or not someone has a mental illness may pale in significance when compared to the improvements it brings to our individual and social lives. Or that the space to reflect during therapy leads to people deciding to work less and is actually bad for the economy. Many of the benefits wouldn’t be measurable in economic or any other terms. The challenge is to find a way to collectively weigh up the costs and benefits of an idea like this without reducing it to a purely economic calculation.

Recent articles

Reader Comments