The Guardian reports this morning that:
The health secretary, Wes Streeting, has ordered a clinical review of the diagnosis of mental health conditions, according to reports.
Streeting is understood to be concerned about a sharp rise in the number of people making sickness benefits claims because of diagnoses for mental illness, autism and attention deficit hyperactivity disorder (ADHD), the Times reported.
They added:
He has asked leading experts to investigate whether normal feelings have become “over-pathologised”, the newspaper said, as he seeks to grapple with the 4.4 million working-age people now claiming sickness or incapacity benefit.
Having consulted a medical expert on this issue this morning, I am advised that anxiety has no medical diagnosis, as such. A person tells a GP they are anxious. The GP then asks questions about the issues troubling them, and agrees it is likely they are anxious. That is because anxiety, like pain, is a subjective phenomenon, and as such, the doctor must accept their patient's description of reality. A doctor would never deny a patient's pain. Nor can you deny their experience of anxiety, because anxiety is a form of pain. And, it is stressed, this is not like diagnosing measles: there is no rash.
What are the likely causes of this pain? Start with this list:
- Poverty
- Insecurity
- Poor housing.
- Inability to have other medical conditions treated.
- The impossibility of meeting children's needs.
- The burden arising from caring, most especially for those for whom other help is not available.
- Alienation from a society that continually tells people their lives are inadequate and that they are failing, most especially through the medium of advertising, whose aim is to deliver this message.
I am sure you can add one or two more. The point is simple, however. This pain arises from the deliberately constructed division within society that occurs as a result of the adoption of neoliberal thinking, which has as its goal the creation of that division as a result of its desire to promote the well-being of some at cost to others. That is the explanation for what is happening.
And what of autism and ADHD? Autism and so-called attention deficit hyperactivity disorder (ADHD), as well as AuDHD (where people have both such conditions), are not "normal feelings that have become over-pathologised". These are descriptions of people who do not think in the same way that most people in society do.
Autism is a different way of experiencing the world. Social rules can feel unclear, and sensory input can be intense or unpredictable. Many autistic people find comfort in routine and immerse themselves deeply in interests that matter to them. It is not a defect but a distinct way of thinking that can bring clarity, honesty, and unique insight.
ADHD is characterised by a brain driven by curiosity and energy. Attention follows interest, not instruction, which can make organisation and waiting difficult. Ideas arrive fast, sometimes too fast, but that same quick thinking creates creativity, spontaneity, and enthusiasm.
AuDHD is when autism and ADHD coexist, which is a mix of structure-seeking and restless energy. Focus can be intense yet easily disrupted, and sensory experiences can be vivid. It brings challenges, but also originality, passion, and a perspective that sees possibilities others miss.
The fact is that the "normal feelings" of people with these conditions are simply different from those of the majority of the population, but when we have an economic system that demands uniformity, conformity and subjection without ever questioning why, those with autism, ADHD and AuDHD are those who will always question and challenge the system. They, in other words, are those who will say the system is broken, corrosive and irreparable. What is more, they are also the people most likely to come up with the alternative views that will change the system.
So what is Streeting really wanting to do? His goal is to suppress those who challenge neoliberalism, whether based on the subjective experience of the oppression inherent within it, or the refusal/inability of some for entirely natural reasons to comply with its demands, as well as their inherent ability to challenge it.
This is not a mental health review in that case. This is about thought control. And this suppression of potential dissent is, of course, inherently fascist in nature. In political economy, that is the only fair description of it.
We do, of course, need a politics of care to replace this toxicity.
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When I first started doing counselling I was amazed that many colleagues seemed to ignore the social context and focus on individual pathology. I didn’t always do as I was supposed to but things changed, thankfully, as the years passed.
With people referred by employers, I often felt the organisation needed therapy more than the people. A lot of modern management seems to use shame to discipline their workforce.
We also need more psychologically informed polices from govt. in welfare, education and housing for example.
But some anxiety emerges from the modern world in a way we probably don’t wish to reverse. We have more choice about the sort of life we lead (though being reduced by neo-liberalism ) .
20years ago fewer Asian minorities presented to counsellors and the usual explanation was their society placed expectations on them which reduces dilemmas and anxiety. But they are more aware that alternatives exist for personal relationships, education, work and gender roles. A lot of anguish goes unrecognised. The issues can be addressed with empathy and care.
Bergman in the Reith lectures asked why humans conquered the globe? He said ‘The secret of our success is…the desire to work together, to protect the weak, to recognise the inherent dignity of
everyone. This connects to my earlier point about the need to expand the moral circle.’
Care is not an optional extra ‘if we can afford it’. It is basic to our existence.
Much to agree with
“many colleagues seemed to ignore the social context and focus on individual pathology”
Half a lifetime ago I did quite a lot of student counselling, and my supervisor often reminded me to look out for the “hand on door syndrome”. After listening for 40 minutes to the immediate concerns of the client, just as they leave – literally with their hand on the door knob – they would hesitate a moment and say, “Oh, and by the way, there’s this … ” and out would come the starting point for the next few sessions. Those starting points very often involved the social context, or issues that in the end were buried deep in the past but reinvoked by recent events. Mental health is neither straightforward nor transparent.
In many ways I admire Wes Streeting’s fortitude in the light of a tough start, but the same approach will most definitely not suit everyone, and facing down problems at one stage of life can stock them up for later on.
What do you admire about Streeting?
What fortitude?
I am baffled.
Thank you.
Do you know anything about Streeting, his grooming for the top job over three decades, his unsavoury associates (not his family) and sponsors and donors, his utter lack of qualification to be anywhere near the top job, his personal style, and his Bullingdon style behaviour at Cambridge?
God help us when he becomes PM. I fear he will.
Streeting and Fortitude in the same sentence? GOL.
It can be dressed up as they like it – The only reason for this is to cut social security to people who need it most.
I go back again and again to the work of late clinical psychologist David Smail. Time to re-read Illusion and Reality.
Why cant we have Politicians who are wise, practical and pragmatic?
No plan Streeting is following the no steer/Rachel/genius boy mantra “we can’t afford it and must cut the out of control benefits bill”.
As you write there will be no sensible review of this or anything else by no steer etc.
Puritan ethics and it’s all your personal fault still rule.
The UK is stuck in the neoliberal doom loop.
May be Streeting is also confusing cause with effect. One of the other causes of the pain of anxiety is the actions of today’s political class……
You might need to explain that very slowly to Wes
Mental health conditions are largely invisible, and therefore easy to attack by those seeking to balance the books or those driven by ideological motives. You aren’t autistic, you are just weird. You don’t have ADHD; you are just poorly behaved. It’s easy to dismiss. Anxiety is an easy one to attack, because it is both an emotion and a condition. Being anxious about an exam is normal, but being anxious all the time, Generalised Anxiety Disorder, a condition that usually comes about due to past trauma, is not normal. I’m sure Streeting knows this, but doesn’t care.
On another note, the two-child benefit cap has driven many desperate parents to push for disability benefits for themselves or their children to make ends meet. Perhaps if people were paid properly and cared for, then the benefits bill would go down. Perhaps if the whole country weren’t an ultra-competitive, anti-social, unequal hellscape with big business, tech companies, and political ideologies invading every aspect of public life, driving us apart and breaking us down into financial units, people would be in much better mental health.
It’s another example of focusing on one particular thing (increasing benefits bill) and seeking to reduce that rather than stepping back and looking at everything that is happening (struggling to afford the necessities, job insecurity) and working to improve those for everybody.
Craig
With ADHD at least, there is a lot that’s misunderstood.
“That’s not ADHD! We all do that!”
Its not about “the thing” you’re doing that’s important.
Two things are important. 1, how often does “the thing ” occur, and 2, how much does it impact the person’s ability to manage and organise their everyday lives – or something along those lines at least. I’m a neurodivergent person, not a medical professional but that’s how I understand it at least.
TLDR; We all gotta take a p*ss too but it you’re doing it 20 times a day you should perhaps consider seeing a doctor.
If Streeting “knows” the problem is over-diagnosis, why bother setting up enquiry? Any different answer won’t be acceptable.
Agreed
He has pre-supposed the outcome.
There is a book on this topic of capitalism’s relationship to neurodivergence called “Empire of Normality: Neurodiversity and Capitalism” by Robert Chapman. I bought it but haven’t got round to reading it yet.
I have
It is good
That sounds like a good recommendation
John Harris’s book Maybe Im Amazed and the podcast is great on a more personal experience of severe autism and dealing with the ‘systems’ set up to support or rather not support people.
Given his obsession with technology, Im waiting for SillyBoy Streeting to announce an NHS AI bot for people with ADHD, Autism or whatever to treat themselves with.
I agree re John Harris’ work. What my medical adviser (Jacqueline) also suggetss that is that autism as John’s son has it and the autism Streeting refers to are as alike as diabatese types 1 and 2 are: they need new names to differentiate them. The current situation is very misleading in both cases.
Hi Richard
ADHD is significantly more complex than what you have written – it is a genetic disorder, that affects executive function in the brain, a neurodevelopmental disorder that needs to be picked up early to treat it is highly comorbid with other neurological disorders – like Bipolar. ADHD is self regulation disorder that affects life in many respects and is highly fluid – it presents differently in individuals. ADHD has had a lot of skeptics in the UK health professions and this has prevented ADHD diagnosis in adults for decades. Dr Russell Barkley, the preeminent expert in ADHD told me that the UK is where the USA was in 1988 for adult diagnosis.
ADHD affects health of individuals – diabetes, poor dental care, cancer etc are extremely common in people with ADHD.
I have ADHD – my children have ADHD, my sibling and parents have ADHD, grandparents, great grandparents likely had ADHD. All undiagnosed- except for my brother and myself and my children. I have witnessed how ADHD has impacted my family.
Many thanks, Craig.
And I entirely agree, ADHD and AuDHD, plus autism are all much more complicated than I wrote, of course. I know. I do not have a diagnosis, but I have my own suspicions. I know many with them, and in the case of some specialists, know what they say about me.
All these can have massive impacts, and Streeting shows not one iota of appreciation.
But I disagree on one thing. These are not disorders. They are normal and they survive for a reason. There is real value to society from having people with these conditions in it. Such people are the source of most change and much creativity in our society. They are strengths neoliberal thinkers want to crush. They hate creativity and challenge.
As someone with Type 1 Diabetes and ADHD I had to have the latter diagnoses and treated privately at one stage while for the former I control the condition well and dont need to see a doctor but I am waiting 2 years to see a diabetes specialist. When things become too expensive Wesley Streeting (Future Prime Minister at large) will continue to push people down the private route – like in the USA – your money or your life.
Thankfully the NHS then takes over with joint care agreements so the private care costs were small.
I think the NHS is on the chopping block for big private insurance companies.. watch this space!
Thanks, and you are almost certainly right.
It is very sad and deeply worrying that it has become normal for so many people to live with unbearable stress and anxiety, and that mental health services are stretched so thin. Streeting’s lack of empathy and understanding, his ‘reduce the numbers’ thinking, is alarming. To be dumped with inadequate care and inadequate benefits with the additional insult of blame piled on top is inhuman. ‘Normal feelings’ my foot! Wes cannot imagine standing in any shoes but his own.
Thank you Richard, Jacqueline, Ian S and others. Do I imagine it or can I feel a video coming on? Most of us will know someone who is suffering with this, but most quietly carry on.
There is a video on Streeting.
Should I do one on this issue, which I know quite a lot about?
I don’t know how you maintain your enthusiasm Richard. Following up on Zack Polanski’s interview on the Rest is Politics, I’ve just endured Rory Stewart labelling MMT as left wing populism, that would create a closed economy which would cause the countries economic collapse (he’s spent 4 hrs reading about it – so he’s very knowledgeable now).
More of the same then; because that’s working…
There’s a technical term for people like him. I think it rhymes with banker, but I am struggling to recall it.
Wes Streeting might not be a ghoul. But he certainly seems to mark an art form of denying inconvenient truths and misrepresentiing reality.
Its the same character trait that attributed cholera and malaria to bad air, scurvy to indiscipline, ulcers to spicy food, IBS to being too emotional. Just wait until he hears about hypermobility and connective tissue disorders –
https://thescienceofwellbeing.uk/the-hidden-overlap-neurodiversity-and-hypermobility-what-science-finds/
Yesterday he called doctors childish, today I call him ignorant and a menace to society
There will be a video tomorrow
Thank you, both.
He has also called the BMA a cartel and the medical profession middle class, implying they defended their middle class producer interests and were snobs.
There’s a lot to be said about Streeting. The late and great Dawn Foster was spot on about him.
🙂
I won’t repeat it, but there is a lot to agree with in what she said
After finding your work on YouTube and now reading this article it seems to me that these views are probably closest home to my political viewpoints although i have to admit the precise details within MMT are still being developed! But this is not the only interesting thing
After listening to the ‘…our idea of ‘capital’…’ video it appeared to me also that something at the core of this ‘cultural war’ (discord?) is the absence of a spiritual cohesiveness, understanding, or recognition which might also represent a ‘capital’ of sorts — and is possibly foundational to other beliefs. Ie, in the same way idealists proclaim consciousness to be foundational and materialists view that it’s matter.
This view seems also to be shifting, from time spent researching and participating on the internet. A renaissance of sorts in the field of religion and spirituality, religious history, NDEs, UFO, dreaming and consciousness
The views you made about AD/Autism have also occurred to me for some time, and I think experts are increasingly unclear at to what this is really. As you put it, managing ideas about what is normal, or natural, is exactly how to deal with other difficult questions instead of seeing individuals as feedback to the system and not like the problem itself. Common i suspect until there is a political motivation which benefits the cause of influential persons. Hence corrupting the idea, such as i believe happened with climate change politics. When really, this started of as environmental concern for pollution and preserving natural habitats
this type of opportunism does not seem optimum, but there is always the hope that once enough of the cake is eaten more sense will prevail
Best of wishes, Harrow
I fere to this issue in my book ‘The Courageous State’.
I have to say today’s story comes over as another example of Labour’s performative cruelty like cutting universal credit for the disabled, again devising ways to increase the hardship experienced by disadvantaged people. But there is a genuine underlying question, there is variation in all human qualities and we shouldn’t automatically pathologise those who differ from us.
I was made very aware of this earlier this year in my work as a school governor. Governors are required to review and approve school policy documents, and before the summer GCSE exams we were presented with one which was actually a national exam board policy with school-specific elements of how responsibilities would be met. This one had a section about giving extra time to students with learning difficulties. In this national scheme, the need for extra time is assessed by students taking a standardised test with the results normalised to a value of 100 for the average person of their age and a standard deviation of 15 (the same sort of scale that is used for IQ). Extra time is given to all who score below 85.
Basically that means a child is labelled as having a “learning difficulty” when it is part of normal variation – the maths of the scoring implies what is actually called a normal distribution. And mathematically about one sixth of all children will be given that label. Now I am in favour of children being given any adjustments they need to demonstrate their capabilities when it comes to an exam result that may be important for their future opportunities, but I worry about them being given a label. And I wonder if other features of normal variation are inappropriately being used to label people.
In particular, people think in different ways. That is normal, and is why people are good at different things in life. Someone who is good at emotional and improvisatory communication as an actor might struggle with a task needing precision and order which would suit someone else. Neither should be labelled as having a disorder because they have qualities different from the average. There are genuine cognitive pathologies (often related to genetic or developmental problems) but the labels shouldn’t be used to medicalise people on a normal spectrum but towards one end.
However I fear Streeting’s review will be about the money, not the human beings.
Agreed
But let’s be clear: autism, ADHD and AuDHD are challenges in schools where uniformity is key for most delivery. So lebelling is right, but only if used to indicate need. And as I have already noted, people with these conditions are often very creative and also challenging – qualities we need, but which standard thinkers find hard to accommadate and understand.
So, a politician presiding over a failed administration, a failed department is ignoring – purposefully – the effects of his maladministration – as though he thinks that this has no effects on folk at all? That no one is worried, or feeling worse?
Is Wes Streeting the Marie Antoinette of British politics?
Streeting is another Labour politician in the Blair mould. Their most telling characteristic is an inability to distinguish left and right (and right and wrong).
Its not my intention to characterise neurodiversity as a medical disorder by the way. Maybe a better example would be to say that being gay was considered a psychiatric disorder up until the early 70s. Incalculable damage was caused as a consequence
I gree: neurodiversity is not a medical disorder, or any form of disorder. It is how somew people are. The problem is Streeting pretending otherwise, and pretending that we don’t live in a world designed to penalise nonconformity with the norm.
I have experience in fairly recent times
grown up daughter 2 decided she wanted official recognition of her autism (we were fortunately able to pay for privately rather than wait 3 years+) and it has set her free mentally and emotionally. She is a confident and successful young woman.
Daughter number 1 descibes heself as neurospicy and has classic ADHD traits but does not want to pursue “diagnosis” for fear of stigmatisation. She is also a confident and successful young woman.
🙂
The point is, knowing matters and sets people free.
Streeting wants to leave people in the dark and blame them.
Only one of those choices is ethically acceptable.
This strategy of targeting a minority whose existence challenges the established order echoes the Tories’ stitching up the Cass Review on puberty blockers for trans teens, which was demolished by more than 15 professional bodies around the world (including the BMA). The goal was the same, to problematise an established treatment to delegitimise a group of people.
Noted, but I am not going to host discussion on this issue – because after a bruising week I have not got the energy to do so.
Spot on. Is it any wonder that claims are on the up. We live in a country that active avoids reality. If Streeting was any kind of a leader (which he is demonstrably not) his first action on learning of an upward trend would be to ask the questions, why and analyse the scale of the issue. Having ascertained the results he would if he cared (which he clearly does not) apply the solutions.
Streeting presides over a department which is falling to pieces, it is absolutely shambolic. Everywhere I look I hear of appalling deficiencies; seriously ill people with multiple medical conditions waiting inordinate amounts of time for treatment. Disturbingly I am seeing evidence that the complexity of having multiple conditions is not being properly addressed. Doctors now are unable to provide care because the system is just unable to cope, doctors are now acting like conductors – passing the unfortunate poorly down a very long queue. What satisfaction can there be working in a system that is totally broken? Moreover there is no evidence that those in authority over the NHS have the will or ability to start to tackle its deficiencies. Its extremely depressing.
Much to agree with
Now I have looked after or look after all manner of stuff, either by myself or with others.
Cars, chickens, a Mamod traction engine, Children, Marine diesel and steam engines, vegetable garden, cats etc etc
By and large they all go and everything that should happen does and the things that do go wrong are mostly ‘unavoidable’ – generally stuff and people getting old
How?
Well, read the B**y instructions ‘/ guidebook / don’t do anything obviously stupid etc
So in the same way you could organise things so that as far as is possible you could avoid people getting ill AND mitigate some of the impact if they were ill/neurodivergent/whatever
The Politics of Caring!
But Mr Streeting chooses not to.
With ADHD at least, there is a lot that’s misunderstood.
“That’s not ADHD! We all do that!”
Its not about “the thing” you’re doing that’s important.
Two things are important. 1, how often does “the thing ” occur, and 2, how much does it impact the person’s ability to manage and organise their everyday lives – or something along those lines at least. I’m a neurodivergent person, not a medical professional but that’s how I understand it at least.
TLDR; We all gotta take a leak too but it you’re doing it 20 times a day you should perhaps consider seeing a doctor.