Cosmo Landesman

We’ve become a nation of armchair psychiatrists

We’ve become a nation of armchair psychiatrists
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Are we becoming a nation of amateur psychoanalysts and armchair psychiatrists? We all speak the language of therapy and are quick to diagnose and label friends, strangers and even loved ones. Prince Harry does it to his wife Meghan Markle in a forthcoming five-part series on mental health for Apple TV that he’s co-produced with Oprah Winfrey.

Discussing his wife’s suicidal state of mind during her pregnancy Prince Harry offers this diagnosis: ‘The thing that stopped her from seeing it through was how unfair it would be on me after everything that had happened to my mum, and now to be put in the position of losing another woman in my life with a baby inside of her, our baby.’

That’s a rather simplistic diagnosis. Anyone familiar with the reality of suicide knows that the truly suicidal are in a dark place way beyond any considerations of what’s fair or unfair to loved ones.

Still, when it comes to mental health we all like to play Dr Know-It-All. Consider the term ‘on the spectrum’. You hear it all the time. It’s a condition diagnosed and discussed just as much at dinner parties as in consulting rooms. So ubiquitous is the practice of declaring someone ‘on the spectrum’ that I wonder: is there anyone who isn’t ‘on the spectrum’ these days?

We hear the term and we dutifully nod in agreement, without the faintest idea of what it really means. Ask for clarification and you get something like: ‘Oh you know, he’s a bit… aspergy’ or ‘She’s a touch autistic’.

But shouldn’t we be a bit more careful about sticking these sorts of labels on people? Of course some people really do have Asperger’s, and it’s no joke. But I’ve noticed that ‘aspergy’ has become a catch-all phrase for people — particularly teenage males — who are just very shy or socially awkward and withdrawn.

Another popular term that is casually banded about is narcissism. Everyone I know is convinced that everyone they know is a narcissist. I have a friend who only talks about herself, her career and her amazing kids. She regularly denounces her ex-best friend as a ‘total narcissist’ for talking about herself, her career and her amazing kids.

Yes, people talk about themselves all the time, pausing for a few seconds to ask a polite and perfunctory — ‘and how are you?’ — before quickly returning to their favourite topic: themselves.

Exasperating, yes. Narcissism? No. Self-preoccupation is not the same as narcissism. The narcissist is someone for whom self--preoccupation has turned into self--obsession; they demand your constant attention, adoration, love, and give nothing in return. I’ve noticed that whenever a relationship ends badly, it’s not because of an intricate series of factors in which both partners carry some degree of responsibility. No. It’s because he or she is a ‘total narcissist’. But to say you were seeing a narcissist sounds much more serious — much more psychologically complex — than if you were seeing a common or garden self-obsessed idiot.

It’s not just that we casually stick labels on other people, but people are happy to stick some on themselves. ‘I’m a neurotic,’ a friend tells me; ‘I’m a hypochondriac,’ declares another. I have three friends with OCD, a couple of bipolars, two ADHDs and one self-professed sex addict.

They may or may not really have such conditions — but with the exception of my neurotic, none of them have had a serious diagnosis by a qualified doctor or therapist. It’s as if they’ve gone into the shopping mall of mental maladies and glammed up their humdrum dissatisfactions with grander-sounding terms. So what used to be called melancholy or having the blues — and was regarded as a normal part of life — is now called depression and needs to be treated with medication. Unfortunately, millions of people with real, life-crippling depression know the difference.

Therapeutic labels are subjected to the same whims of fashion as the labels of designer clothes. Around five years ago, I joked that being bipolar had become as trendy as being bisexual had once been. People who were subjected to radical mood swings were no longer suffering the ordinary ups and downs of life; they were bipolar and proud. Then along came OCD (Obsessive Compulsive Disorder), a condition once associated in the public mind with the bearded and bonkers Howard Hughes. Suddenly people suffering from OCD started to pop up all over the place. I once asked a friend why he thought he had OCD and he told me: ‘Every time I go to the loo I have to wash my hands. It’s a compulsion.’ ‘No,’ I said, ‘it’s common sense.’

I must make it clear that I’m not talking about the vast majority of people with serious mental health problems that cause terrible suffering. I’m referring to a small minority of affluent middle- and upper-middle--class metropolitan types. They are the descendants of Europe’s haute bourgeoisie who in the 19th century regarded conditions like melancholy or nervous disorders as the mark of a refined sensibility and even a creative temperament. They regularly checked into European sanatoriums and chic spas outside of London where they could flaunt their maladies among fashionable folk. In the 20th century, when psychoanalysis became all the rage, they headed for the consulting rooms of Freud’s Vienna and Jung’s Zurich.

I know many people who are on medication or in therapy — people with good jobs, friends, various degrees of success and yet who are so unhappy. One obvious explanation for this is the impact of lockdown on our mental health. But people were miserable before lockdown and, after a brief rally, I bet they will be miserable again post-lockdown. In fact, I don’t know anyone who would describe themselves as happy or even just sort of happy. This is particularly true of the young, for whom happiness is never cool. A legacy of 19th-century romanticism and 20th-century pop culture is the idea that happy people are plastic people — ‘shiny happy people’, as REM put it. Suffering, by contrast, is seen as sign of authenticity and soul.

The temptation to join the walking wounded and embrace therapeutic terms to upgrade common ailments is greater than ever. It gives your suffering, however small, a social significance and your condition a moral authority that ordinary unhappiness doesn’t confer.

Consequently, it’s no longer enough just to be deeply unhappy or depressed — now your tale of woe needs the narrative upgrade of suicidal thoughts. But thoughts of suicide — which many people have and which are mostly fleeting — is not the same as being suicidal. It just makes your misery sound more significant and elicits more sympathy.

I’m not trying to trivialise the situation of those who suffer bad mental health. On the contrary, this is too important an issue to be used by attention-seeking activists, celebrities and even the odd royal.

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