Published in response to the following article in the Metro: https://metro.co.uk/2016/05/30/england-star-raheem-sterling-puts-improved-form-down-to-psychiatry-sessions-ahead-of-euro-2016-5912582/
So Raheem Sterling (England, Manchester City) has admitted to seeing a psychiatrist. This is news because? After I read the piece, I was in two minds about which bit of this ‘news’ is newsworthy. That he has been seeing a ‘psychiatrist’, or that he was bold enough to admit it? Kudos to Sterling, for owning up to seeking help from outside the usual suspects – his coach, physio, agent and whatever entourage a modern day footballer with wages of £200,000 per week has. But why not? Did The Royal College of Psychiatrists not run an anti-stigma campaign (Changing Minds 1997-2003) with much hoopla? I remember they found that the people with mental illness find barriers in all walks of life. Shocker! After running the campaign for almost a decade, it faded into public unconsciousness. Whatever it was, as a practicing psychiatrist in various settings since, I have failed to detect the impact among the people who comes to us. There remains a huge stigma about mental illness, and this gives rise to many forms of discrimination, from subtle to ridiculous, in all sorts of ways that the Equality Act 2010 cannot redress. Think about it. Would you put in your pre-employment health questionnaire that you suffer(ed) from depression?
As psychiatrist I know all about the stigma of mental illness. I know about patients who are hidden from the society because they are ‘mad’, the (arranged) marriages that gone sour and the lives ruined because the mental illness was not disclosed. I know patients whose family hold on to the coattail of denial because admitting it would reflect badly on them as parents, and on the community. I have seen communities condoning behavior so diabolical and out of line, that it would raise hair on your neck lest acknowledgement of illness brings ‘shame’ on the community. And I am not talking about the so-called ‘developing countries’ or immigrants.
I have often wondered why it is ok to talk about your cancer, your diabetes, your Viagra, your heart attack and subsequent ‘triple bypass’; but not about your phobias, your depression, or you feeling like ending it all. I do not have the answer. From my experience of over two decades, in ‘developed Western cultures’ no less, has led me to firmly believe that people simply do not consider mental illness as an illness. It is seen mostly as a sign of ‘weakness’, almost always ‘self-inflicted’, much like ‘feeling sorry for yourself’ and to overcome this you need no more than ‘pull your socks up’ and get on with it. I do not think the College campaign failed because the heart was not convinced, I think it failed because we thought ‘what is in it for me?’ Instead the Government of the lost years between 1997 to 2010 thought it was appropriate to scare the living daylight out of its citizenry by depicting the mentally ill as the ‘bogey man’. Although the incidence and prevalence of serious psychotic mental illness (the ones that are known as ‘psycho-killers’ or ‘Crazy’) has remained essentially static, over the years and across cultures (roughly 1%), the Government tried to introduce laws which would ostensibly keep our communities safe, with the unintended consequence of piling on the stigma on the so afflicted.
While the Government was up to this chicanery, we psychiatrists did not help matters much. The word ‘dangerousness’ had fallen into disuse, being replaced by the the more acceptable word de jour ‘Risk’. Suddenly ‘risk assessment’ became a growth industry, with the academia fought a fratricidal battle to see who can make the best ‘tool’ for prediction of what is essentially unpredictable. Some people did rather well riding on the ‘risk-violence’ bandwagon (I know of a psychiatrist who was given a Chair in a reputed London University because apparently there was a new treatment method which will make dangerous mentally ill criminals docile as “Bambi” the piglet, a treatment method that had passed most of us by), while the poor sufferers, not so much. Risk assessment was the field to go into, and earning a fortune through use of ‘Risk-assessment tools’ was not uncommon. One such entrepreneur became such a celebrity that he is rumored to travel with his band of personal bodyguards. But I digress.
So what has Sterling admitted to the papers that made it to the headlines? Well, he has admitted to ‘seeing a psychiatrist, Dry Steve Peters’ to get his focus on. Now we cannot all be as lucky as Dr Peters who famously helped a certain football club (which had Sterling amongst its squad) in the North-East come within few points of winning the Premier League championship. After the hype died its natural death, Dr Peters did not make the papers as much although he did ‘assist’ the backroom staff of the England national team to reach the undeniable glory of being eliminated in the group stage in 2014 World Cup in Brazil. Now Dr Peters, a medical doctor, hence called a ‘psychiatrist’, is back helping the England team for Euro 2016. But it is not about Dr Peters, this is about Sterling.
When Raheem Sterling was playing for the team that almost won the Premiership, he did not have any reason to see Dr Peters. He was a huge talent, earning a pitiful £20,000 a week (going up to £70,000/week) but he had to go to ‘bigger club’ to fulfil his dream of winning things. Now no one in this world would begrudge him for chasing his dream, (except the diehard supporters of the Merseyside club wearing all-red kit) when the dream chasing has just hiked his wages by a factor of 10. But things did not quite work out the way Sterling had planned. In a season at the ‘bigger club’, he won not much, and he went so far down the pecking order, both in his club and the Country that the services of Dr Peters were imperative if he were to make it to the final 23.
So here is what he did. With the help of Dr Steve Peters, he admitted to ‘getting my mentality stronger’. Dr Peters, according to a grateful Sterling, ‘just gets it into your head that mentality is key and a strong part of it is blocking certain things out and focusing singularly on your football’. Not only that, he disclosed that not only he has been ‘seeing him here with the national team’ but that ‘most of the boys do’. Now you would not imagine your dream team to be full of ‘weak’ people, who ‘feel sorry for themselves’ would you? It’s not as if all they need to do is to ‘pull your socks up’,
Let’s stay with Sterling. He has in his simple way crystalized what is it we do. We ‘get it to your head..’ and help you ‘focus singularly on your…’ in whatever you are struggling with. We ‘Shrinks’ (a decidedly American slang for psychiatrists but nothing comes closer in English that encapsulates the whole bunch of mental health professionals who are in the business of helping you ‘to get you there’) do just that. We are the very long pole the tightrope walker uses to balance himself. We are the ‘safety net’ underneath that treacherous walkway you rarely see on TV.
One of my favorite analogy is that of the farmer. A farmer, as you will no doubt know, has a piece of land. But it is full of weeds and unsuitable for cultivation. To make it productive as an agricultural enterprise, you have to weed it, plough it, fertilize it (feel free to use Organic stuff if you are so inclined) and plant the right seeds. Then you sit tight, wait for the harvest, and we will even see you through the fluctuations in market. We, are the ‘Shrinks’, who will be there for you, who will not take sides, who will not judge you. We provide you with a safe, protected place where you can discuss your fears, your anxieties, your weirdness. There is a division of labour though- the psychiatrists like me (not sure about Dr Steve Peters) who mainly prescribe medicines are the ones helping you with the weeds (no pun intended), the fertilizer and with choosing the right seeds. The ploughing or tilling of the soil is done jointly by you, your therapist and your existing support network. And when it is harvest time, we will cheer you and we will enjoy it with you. You know, because ‘everybody needs help, sometimes’.
But for Raheem Sterling, let us hope it is a very decent harvest.
By Consultant Psychiatrist Dr Sameer P. Sarkar, MD, FRCPsych