Why treat people and send them back to the conditions that made them sick? The woman looked at the very picture of misery. Her gait was almost apologetic, she approached the doctor and sat down, huddling into the chair. The dreariness of the outpatients clinic, unloved and uncared for, could not have helped. It certainly did nothing for my mood. ‘When were you last time completely well?’ asked the psychiatrist in a thick middle-European accent. Psychiatrists are supposed to have middle-European accents. Even in Australia, this one did. ‘Oh doctor,’ said the patient, ‘my husband is drinking again and beating me, my son is back in prison, my teenage daughter is pregnant, and I cry most days, have no energy, difficulty sleeping. I feel life is not worth living.’ Thinking of getting hair extensions? Lucy Hall and her team are experts at helping you find the right type of extensions to transform your hair.
It was hardly surprising that she was depressed. My mood dipped further. As a medical student in the 1960s I was sitting in Psychiatry Outpatients at Royal Prince Alfred Hospital, a teaching hospital of the University of Sydney. The psychiatrist told the woman to stop taking the blue pills and try these red pills. He wrote out an appointment for a month’s time and, still a picture of misery, she was gone. That’s it? No more? To incredulous medical students he explained that there was very little else he could do.
The idea that she was suffering from red-pill deficiency was not compelling. It seemed startlingly obvious that her depression was related to her life circumstances. The psychiatrist might have been correct that there was little that he personally could do. Although, as I will show you, I have come to question that. To me, that should not imply that there was nothing that could be done. ‘We Should be paying attention to the causes of her depression. The question of who ‘we’ should be, and what we could do, explains why I discarded my flirtation with psychiatry and pursued a career researching the social causes of ill-health and, latterly, advocating action. This is the result of the journey that began in that dreary outpatients clinic all those years ago.
And it was not just a question of mental illness. The conditions of people’s lives could lead to physical illness as well. The inner-city teaching hospital where I trained in Sydney served a large immigrant population, at that time from Greece, Yugoslavia and southern Italy. Members of this population, with very little English to explain their symptoms, would come into the Accident and Emergency Department with a pain in the belly. As young doctors we were told to give them some antacids and send them home. I found this absurd. People would come in with problems in their lives and we would treat them with a bottle of white mixture. We needed the tools, I thought, to deal with the problems in their lives.
A respected senior colleague put it to me that there is continuity in the life of the mind. Perhaps it is not surprising that stressful circumstances should cause mental illness, he said, but it is inherently unlikely that stress in life could cause physical ill-health. He was wrong, of course. I did not have the evidence to contradict him at the time, but I do now. The evidence linking the life of the mind with avoidable ill-health will run right through this book. Death, for example, is rather physical, it is not just in the mind. We know that people with mental ill-health have life expectancy between ten and twenty years shorter than people with no mental illness. Whatever is going on in the mind is having a profound effect on people’s risk of physical illness and their risk of death, as well as on mental illness. And what goes on in the mind is profoundly influenced by the conditions in which people are born, grow, live, work and age, and by the inequities in power, money and resources that influence these conditions of daily life.