Stephen Fry and depressionWhen it comes to provoking an open and honest conversation about mental health – and more specifically, depression – few people are more successful worldwide than UK author, TV personality and actor Stephen Fry.

As president of mental health charity, Mind, and as the author of numerous documentaries and autobiographies detailing his own battles with depression, he has been outstanding in introducing discussions around mental health into mainstream media, creating awareness about and battling against its stigma, and fundraising countless millions of dollars to help research into treatment and help for those seeking treatment.

But when Fry earlier this year released a 10-year follow-up to his ground-breaking documentary The Secret Life of the Manic Depressive, he provoked a fierce debate between those who see depression and bipolar diagnoses from different points of view.

Although Fry’s documentary was optimistic about increased awareness surrounding mental illness – especially around young people – and gave excellent insights into those who live with bipolar, many felt that he relied on a point of view which divorced psychiatric disorders from life experiences and preferred to see them as biological brain conditions reliant almost entirely on genetic predispositions.

The trouble with this view – and it’s something which at Robert Street Clinic we experience frequently – is that it misses the fact that there is no specific line between “healthy functioning” and severe psychiatric disorders (there’s even evidence that and some severe psychiatric disorders are not even separate conditions) and, hence, looking for a textbook medication for a textbook diagnosis ignores the more complex debate around trigger events in people’s lives and the environment in which they live.

In an open letter, widely republished in media throughout the world, University of Liverpool Professor of Clinical Psychology Richard Bentall, pointed out that Fry’s documentary had revealed personal episodes had been triggered by events on two specific occasions and that Bentall’s research has “pointed to a wide range of social and environmental factors that increase the risk of mental health”.

The risk of ignoring environmental and traumatic impact on mental health – in not looking hard at early lifetime influences such as bullying, physical and emotional abuse, childhood upheaval and poverty; or adult issues such as work environments, debt and relationships – is that it can lead to poor planning for national mental health policies.

Patients who are given an entirely medical treatment aren’t offered the psychological therapies or even the kind of practical tools and counselling (exercise, mindfulness techniques and budgeting advice for example) which can offer real, tangible benefits. And a national mental health policy which chases the “golden bullet” medical treatment would ignore the positive results which follow on from tackling issues such as childhood poverty, inequality, legislation to control addictive substances and behaviours – even urban planning.

But the most important aspect of focusing entirely on mental health as a pre-eminently biological and genetic brain issue is that it panders the very thing which Fry seeks to destroy: stigma. Many of those who joined the debate following the BBC documentary pointed out that, by removing the idea that mental illness can be a product of our environment, it became easy for people to divide the population along genetic lines into those who are mentally well and those who aren’t.

Mental health simply isn’t that precise – and that’s why it’s important to take a more wide-ranging approach to its treatment than simply relying on medication.

For more information on Robert Street Clinic’s approach to treating depression and the individual skills of our wide range of psychotherapists, psychiatrists and psychologists call us on 09 973 5950, email us at info@robertstclinico.nz or message us via the website.