28 November 2019
‘Epidemics’ and ‘Crises’
A historical perspective.
By Lynda Goetz
Each era, not to mention each culture, has a different understanding of life, human behaviour and our relationship with the world around us. Currently, at least in this country, we are living in a time when, on the whole, most of the population have left behind the idea of the world being run by gods or even a God; we have at long last, at least partly, woken up to the long-term damage modern life, consumerism and technology are doing to the planet on which we live; we are groping towards a better understanding of what it takes to safeguard our mental health, as well as technological solutions to the problems we have created.
Headlines this week included ‘Cases of coercive control double as domestic abuse stays at epidemic levels’; ‘3-year-olds stare at screens for 4 hours’; ‘Brain damage detected among obese teenagers’; ‘Police fighting mental health crisis, not crime’; ‘Students with psychological issues ‘hit hardest’ by strikes’; Maternity ward overwork and stress ‘burns out’ third of doctors’ and ‘A dose of ketamine could lessen the lure of alcohol’. This latter fact was actually first reported in the public press back in 2017, following work in the 60s and 80s; however, the point which stands out from all these headlines is awareness of the ways in which our lifestyles are impacting on our general well-being and mental health. What many clearly haven’t managed to achieve is a healthy, well-balanced modern lifestyle. Is it really modern life and technology which is the problem or are most humans simply never destined to attain this nirvana?
Is coercive control really a modern problem? Is it at epidemic levels or has it always been there, albeit in a different guise, or more accurately under different names? It used to be considered ‘normal’ in many households for men to beat their wives and to control what they could and couldn’t do. ‘Shrewish’, nagging wives (to go back to last week’s headlines about the trial of Mrs Walker, who treated her husband like ‘a slave’) are nothing new either; they clearly existed in Shakespeare’s day. What has changed, presumably, is the fact that this is no longer considered acceptable, nor is it simply a private matter, but has become a public issue. At a time in history when we consider our personal independence to be of importance, it is no longer acceptable for one partner in a relationship to exert control over the other.
‘Screen time’ is a very recent problem. We have very little idea what hours spent in front of screens (whether watching, writing or interacting) does to the adult brain, let alone the developing brains of babies and toddlers. Back in April, the World Health Organisation (WHO) issued guidelines suggesting that what they called ‘sedentary screen time’ should not happen before a child is two; two to four-year olds should be limited to an hour, less if possible. A part of the problem, leading to mental health issues in later life, may be the reduced interaction with parents/care-givers and other children which this sort of behaviour undoubtedly promotes. In the UK there is no specific advice on screen time limits, although use before bedtime is discouraged. There is still a lack of definitive evidence on the possible long-term harms or benefits of screen time on small children. One of the main concerns of the WHO is the lack of exercise and inactivity which results from passive viewing. This is a leading risk factor for obesity related ill-health, currently a big problem in the developed world, particularly in the UK and America.
Does obesity in children lead to brain damage or did these children have different brains before becoming obese? The recent study carried out in the US led by Cambridge University did not answer this question, but it did find that the obese children had inflammation in the white matter of the brain. The regions affected were responsible for control of appetite, emotions and cognitive function. Just six days ago the German broadcaster Deutsche Welle (DW) published, in its online magazine, the fact that ‘4 out of 5 teens do not exercise enough: WHO’. Other studies show the connection between exercise and mental well-being. As the numbers of those who eat too much and do not take enough exercise increase, we are sitting on a ticking time bomb not only of physical ill-health but mental ill-health as well.
Why, you might well ask, does this involve not only our medical services, but our police force? It appears that in this country, 40% of police time is spent dealing with people who are mentally ill, rather than fighting crime. According to John Apter, spokesman for the Police Federation, officers now devote 80% of their time to non-crime related incidents, the ‘lions’ share’ of which were because of a ‘mental health crisis’. He is reported as saying, “This country is in the grip of a growing mental health crisis and my colleagues are at the very forefront of trying to protect and support vulnerable people.” He added, “There is simply not enough investment in the mental health support system. My officers regularly fill in for shortfalls.”
At the same time, Felicity Mitchell, head of the Office of the Independent Adjudicator, was warning that the strike by university workers could adversely affect students with mental health problems. She said that “providers needed to think carefully about additional measures to support these students”. This does seem an excessive demand for dealing with eight days without lectures, but perhaps it depends on how you classify mental health problems. When Melvil Dewey (who invented the Dewey Decimal System for classification of library books) was three he apparently alphabetised his mother’s spices, which in those days was regarded as precocious – nowadays, as someone pointed out, we would problem label him as having OCD.
As for the medical profession, I suspect it is not only those working in the maternity wards who are stressed. But what should we be doing about it? Part of the problem, as I wrote some weeks back,* is the NHS itself and the public’s sense of entitlement. 36 percent of 3,000 obstetricians and gynaecologists studied in a survey met the criteria for ‘burnout’, associated with emotional exhaustion, lack of empathy and connection with others. Amongst trainee doctors, that percentage rose to 42 percent.
As for our final headline, this ties in with an increasing concern about binge-drinking, alcohol abuse and addiction and the way in which for many years, advertisers and social media have shown alcohol as the natural adjunct to ‘having a good time’. However, the use of alcohol to get through difficult times is hardly a modern phenomenon. Indeed, if we look at the different behaviours and attitudes highlighted, is one of the biggest problems the fact that we are looking at all these things differently from our ancestors?
Take work and ‘burnout’. Are doctors today working harder than they did in the past, or is their attitude to life and work simply different? Is the environment in which they are expected to carry out their duties less supportive and more focused on the ‘rights’ of those they are treating? It is interesting that the younger, trainee doctors show a higher incidence of ‘burnout’. This can probably be attributed in part to their lack of experience and hence lower confidence levels. It may also be attributable to a different attitude in the younger generation to work/life balance.
It is not that long ago in terms of the history of humankind that many people were expected or simply had to work 12 or 15 hours a day seven days a week. If you were amongst the ‘lower orders’ in this country you might be lucky to get time off on Christmas Day, which was why many couples used to get married on that day. After a twenty year campaign, the Holiday Pay Act of 1938 introduced for the first time the statutory right to a week’s paid annual leave. By the 1980s four weeks annual leave was common.
The same changes in attitude are evident in regard to aggressive and abusive behaviour and to mental illness. These changes have been particularly rapid in the 21st century. As a result, our approach to behaviour which historically may have been acceptable is no longer tolerant. We should perhaps, however, refrain from jumping to conclusions about these things without at least looking at them in their historical context. Are we really suffering an ‘epidemic’ of domestic abuse or is it simply our modern perception of something which has always been a part of society, but was overlooked and not publicised? Is throwing money at our mental health ‘crisis’ the way to solve it or should we perhaps also be educating everyone from a young age and giving people coping mechanisms to deal with ‘the human condition’? Might better education be the way forward for parents allowing babies too much time passively sitting and watching some form of screen? Knowledge about exercise and diet are at least one essential tool in the war we need to wage on obesity.
All these are ‘First World Problems’ and many arise from contemporary viewpoints and labels. Perhaps in fact what we need is far more teaching and knowledge of history so that we can understand better how these issues have been viewed historically and put our own time into perspective. Maybe then we will be better equipped to deal not only with the human condition, but also to focus on the future.