How to cope with a psychological problem

From a talk given at the British Psychological Society Conference by Raj Persaud, the consultant psychiatrist and author of 'Staying Sane'

A grave omission has arisen in psychology and psychiatry over the last 100 years. What we should have been doing throughout our history, but have almost completely omitted to, is to advise the public on how to prevent the onset of mental illness or psychological problems, rather than simply being so completely focused on only offering treatment once disturbance has set in.

A grave omission has arisen in psychology and psychiatry over the last 100 years. What we should have been doing throughout our history, but have almost completely omitted to, is to advise the public on how to prevent the onset of mental illness or psychological problems, rather than simply being so completely focused on only offering treatment once disturbance has set in.

Prevention is always more efficient and helpful than cure. This major failure of our discipline in the last century has occurred partly because of the erroneous belief that mental illness cannot be prevented as its causes remain obscure. Yet the history of medicine has been dominated by effective preventive action, which occurred long before specific causes were identified.

When John Snow in the 19th century famously removed the handle from the Broad Street pump in London as one of the first historic acts of public health medicine, he did not know at the time that he was saving lives by preventing waterborne infection with cholera. The germ was only to be correctly identified decades later ­ Snow simply observed the association between drinking from this pump and subsequently dying. You don't need to know specific causes to institute effective prevention ­ you simply have to observe an association.

But we know enough about the associations between poor coping strategies and the future onset of mental illness to be able to advise the public now on how to largely prevent most psychological disturbance.

Perhaps one of the most grievous failings of psychology over the last 100 years is the lack of easy consensus among psychologists over what the best coping advice should be. The profession is split into so many contrasting and competing schools ­ the cognitive approach might be in direct opposition to the Freudian position, for example ­ that this has merely served to confuse the public and delayed our ability to assist in urgently needed preventive action.

But I propose to you, perhaps rather provocatively, that all of psychology and psychiatry, all of Freud, all of Jung, all of the research going on all over the world, all of the advice in the journals, boils down to the fact that all coping is merely a variant on one of two basic strategies.

You can act upon your stressful circumstances so as to remove or diminish whatever is upsetting you. This is called "problem solving". A problem-solving approach to an abusive husband would be to get him to stop being abusive by counselling or, if all else fails, to leave him. The only other strategy is to act upon yourself to render yourself less upset by unchangeable circumstances ­ a tactic termed "emotionally focused coping". If you cannot leave or change an abusive husband, you learn to put up with him.

Psychology and psychiatry have managed to disguise from the public that all coping is merely a jargon ridden variant of one of these two steps, and indeed has contributed to emotional distress by overly complicating the area. In fact the main reason why most people get into psychological problems is because they fail to realise that only these two options exist, and embark on a fruitless search for a non-existent third or fourth option. This is usually because they find the first two options difficult to implement and prefer to comfort themselves with the delusion that other possibilities exist. The fruitless search for a non-existent third option merely delays proper coping, so increasing suffering.

What we should have been doing is to explain to the public that those who are resilient are not doing something complicated or special. They have simply grasped that there are only two options in life, and have learnt how to implement them, and which to use when. Above all, they have realised something it has taken psychiatry more than 100 years to grasp: in life, there is no third option.