Brexit In The Psychiatrist's Chair

The UK “decoupling” from the EU after a commitment that’s lasted more than 40 years was due to take place on March 29. There was a referendum in 2016 about whether or not to stay in the EU and, by a narrow margin, the British voted to leave. 

So, theoretically, that should be that. Except it isn’t and, just under three years on, nothing is settled. Remain and leave politicians are at loggerheads and voters are baffled and bewildered. The only certainty we have is continued uncertainty.  

Consultant psychiatrist Dr Robin Lawrence shares his views on the Brexit effect.

"The Brexit effect came to my attention last August when I saw what I thought might be my first case of a condition called Brexit Anxiety Disorder presenting in the form of a middle-aged man. He had been re-referred to me as an emergency, having been discharged more than five years ago after an uneventful recovery from depression. 

"The patient was a Brexiteer who had, according to both him and his wife, become obsessed with the referendum result and its possible consequences. He has family and friends living around Europe. But he had suddenly become convinced that leaving the EU was going to be a catastrophic failure, that the UK would never get a deal, and that the whole country would be ruined.

"He had concluded with great certainty that he had made a terrible mistake and had voted for a policy that would be ruinous for the country he loved. His was convinced his family friends in Spain would probably never speak to him again and his daughter – living happily in Portugal for the past 14 years – would lose her job and be deported. 

"He could not be reassured. The fact that his was only one vote among many did not reduce his guilt nor did the fact that his wife had voted Remain so, as a family, they balanced each other out.

"Phone calls from friends in Spain and long conversations with his daughter could not shift his enormous fear and his personal sense of responsibility for the impending catastrophe. He was not eating, he was not sleeping, and he felt helpless, hopeless, pointless and worthless. He had no libido, his weight was falling, and his memory attention and concentration were impaired. Thoughts of suicide were coming, unbidden, into his mind.

"The diagnosis is, of course, psychotic depression provoked by gross anxiety caused by all the forecasts of doom that he was reading and believing. Certainly psychotic – not neurotic – because of his fixed false belief that he was in some way personally responsible for all this and the vague idea that “they” were coming to get him. His was undoubtedly an extreme reaction and he did respond to medication, but it led me to think further.  

"As I had a possible case in my clinic, I set about seeking the diagnostic criteria described in the literature, only to be disappointed that no such condition has ever been described. So what was the genesis of this interesting meme?

"It started with a light-hearted dig by the site Euro-Guido in November 2017: “For the past few months it has become clear that certain members of the politico-media bubble have been undergoing a Brexit-induced breakdown.” In this sarcastic piece, there is no pretence that the word “mad” was used other than in the lay sense, an insult. It attacked 10 of the usual targets - Andrew Adonis, Jolyon Maugham QC etc.  

"By August 17, 2018, Tom McTague, writing for the pro EU website politico.eu, had interviewed Dr Philip Corr, professor of psychology and behavioural economics at the University of London, and Dr Simon Stuart about this topic. They told him: "For Britain's pro-European middle classes, Brexit is akin to a psychological trauma which has left many unable to behave rationally." 

"By the time the story was tweeted by The Sun, on August 21, the psychologists had morphed into “top doctors and psychiatrists” and a light-hearted critique of “Remain Madness” in a tweet in November 2017 had become "It’s official – some Remoaners are so upset about Brexit they could be suffering from a psychological disorder."

"More than six months after I last saw my patient, the news on Brexit – or not – only seems to get worse. NHS England has complained of a "radio silence" from the Government about contingency plans in case of a no deal and there are warnings of the need for the NHS to stockpile drugs because the European and British agencies will no longer share information. 

"Moving away from my own area of expertise, I read that the Welsh Fishing Industry has said that the entire industry could be destroyed in as little as four weeks without a deal, that planes may be grounded – a claim since dismissed –  that sandwich production would be restricted, food prices could increase by 12% and the supermarket shelves could be empty. Food stockpiling is being recommended in certain situations. The risk of terrorism may be increased because EU and UK agencies will no longer co-operate and PM Theresa May may even be considering putting the Armed Forces on alert to provide emergency aid for the whole of the UK in the event of no deal. 

"There is no such condition described in the psychiatric or psychological literature and yet I had seen a patient, not a frustrated "Remoaner", but with a psychotic depression induced by pre-Brexit anxiety. 

"My single patient led to a Socratic internal dialogue concerning the possibility that he may have been right in principal with a distorted sense of personal responsibility. Could I be confident in my reassurances to him, I wondered? All I was certain of was I just did not know enough about the situation. Certain things I knew were miss-information; the words of the chairman of the medicines agency being turned from something like: “We certainly must consider seriously all options in the case of a no-deal” into headlines in the Independent and Chanel 4 News of: “Medicines Chief fears consequence of No Deal; PM’s own insulin supply threatened.” But what did I know of all the other areas of anxiety that were also his over-riding concern.

"There are common themes within these fears. 

"First, the warnings are expressed by people with authority and come from reliable sources; secondly, the bodies who express them appear to have no particular axe to grind – just the protection of their industry or sector; thirdly, those who express these opinions are apparently doing so honestly. Finally, there are others who can and do reject each and every warning as "project fear".

"We do only have about two weeks supply of medication stored at any one time, and some vital supplies do come from Europe?  Well, yes, although the particular scare story concerning insulin was wrong (direct communication from Novaris the manufacture of the vast majority of all insulin used in the UK with its factory and headquarters outside EU). The fundamental question is this: What does our government think of the nature of the EU chiefs and Eurocrats, or the nature of the governments of our European allies, or the behaviour of the population of Europe for such "emergency measures" to be prudent or necessary?

"I think there is only one possible answer: To imagine that, in the event of a WTO Brexit, the EU would allow the NHS to run out of medication, the Welsh Fishing Industry to be destroyed and the supermarkets shelves to be emptied depends on a small number of possible variables, the most important of which has terrifying consequences.

"To suggest that the EU would effectively starve us into submission to a deal that was not endorsed by the British Parliament could only possibly be true if we believed that the EU was run by a whole load of narcissistic sociopaths. 

"In other words, a group that is only concerned for its own success and is prepared to do anything necessary to achieve that aim. The suggestion is that they would see people die rather than allow medicines through customs to the UK or that they would see industries destroyed by insisting on paper work that (if it were to take more than a few minutes) would cause all the perishable produce to be destroyed. 

"This is a very serious accusation to make about anyone individual or an organisation as can be seen in the appendix. 

"These diagnoses should not be made by anyone without the proper training and not without several hours (or days and weeks) of close observation and questioning of the subject and third-party informants. Such diagnoses can result in a criminal’s detention in Broadmoor for the rest of their life. Nevertheless, it could be argued that someone believes that these are the sort of people the UK is dealing with in Michel Barnier and Jean-Claude Junker and the rest of the EU. Otherwise such provisions as Army mobilisation would be totally unreasonable as a response to WTO deal/no deal.

"Others have said: "No, you don’t understand. It would not be malign intent that starved our NHS of vital drugs, and the destruction of our perishable goods producers, just the inefficiency of the introduction of new systems."

"Even so the accusation remains unchanged.  Only the unconcerned narcissistic sociopath would stand idly by allowing new administrative measures to cause such serious damage without stepping in to facilitate fast-tracking until the inevitable creases in the system had been ironed out.

"So, by spending all this time and money preparing for no deal chaos, the Government is telling the British people a great deal about what it thinks is the nature of our European cousins. It is, of course, unqualified to make such a diagnosis, but the implication is clear. The Government thinks we are dealing with a very dangerous group indeed; it is putting the EU in the same category as, for example, a protection racket, or abusive husband.

"There are only two sensible reactions to such thinking: 

Either, the conclusion is wrong and our long-term allies and near-neighbours are reasonable and decent folk, or

The EU member states are among the most dangerous and self-serving group of people with whom we have formed a relationship and the only rational reaction is to get out of the relationship as quickly and completely as possible, whatever the cost. 

"In the first case, life should go on as normal; in the latter we have a tough ride ahead but the only safe thing to do if in a relationship with a narcissistic sociopath is to get as far away as possible as quickly as possible – at whatever the cost."

By Dr Robin Lawrence

      

Photo by John Cameron on Unsplash

Food For Thought

For my first-ever blog, I want to say something about the fundamental link between how we behave with food and the effect it has not only on our physical symptoms - ie. weight, digestion and energy - but also on our thoughts, feelings and ways of relating.

Personally, I didn’t pay attention to the link between nutrition and mental wellbeing for many, many years. 

This was despite my own experience of the connection between what I was eating and how I was feeling.  

In my early 30s, I was diagnosed with rheumatoid arthritis and was badly affected by joint pain and chronic fatigue. 

At that point in my life, I was a stressed corporate banker often opting for typical convenience food that was slowly but        surely  adding the pounds.  I was also the daughter of a wonderful, but depressive mother who suffered greatly with ulcers and ultimately bowel cancer. I myself had already suffered two deep depressive episodes and questioned if I was genetically destined to follow her medical path.  

Following my rheumatoid arthritis diagnosis, I cut back on meat and dairy products, stopped eating processed food and gluten, and took the decision to eat considerably more fresh produce. Over a period of three months, the joint pain and fatigue vanished!

While I raved about my physical transformation in terms of weight loss and  pain relief, I hardly credited my change in diet for my vastly improved psychological health.  

It was only as the science caught up with my positive, holistic, "felt" experience that I came to understand so much more about how our mental health can be affected - and connected - by the actual physical mechanisms activated by our food 

choices.  

The condition of our gut microbiome - that veritable zoo of trillions of bacteria and enzymes that supports digestion and regulates our weight, is also responsible for the production of essential neurotransmitters (including serotonin, dopamine, norepinephrine and others) which contribute to our emotional wellbeing.  

Adverse childhood events (ACE), post-traumatic stress disorder (PTSD) and continuing, low level stress caused by relationships, finances, work - and even Brexit! - can lead to excessive levels of stress hormones such as cortisol and adrenaline, which can also compromise the delicate balance of our microbiome, in turn depleting our essential neurotransmitters. 

It seems so obvious now, that both mind and body will thrive when we feed ourselves well, resist the CRAP (Calorie Rich And Processed) and work through historic and present day causes of anxiety.

To consolidate my learning in this area, I obtained a Certificate in Plant Based Nutrition from Cornell University and I bring this into my work as a therapist. During the assessment stage with my clients, I will ask about their attitude, preferences and sensitivities to food.   

Unsurprisingly, a tricky relationship with food often accompanies tricky interpersonal and intrapersonal difficulties. In many cases, physical manifestations including nausea, racing heart, and IBS-like symptoms occur that are often longstanding but appear to have no apparent physical cause.

Alongside our exploration of presenting issues (anxiety being a leading presentation), some clients choose to make simple adjustments to their eating habits, such as eating a generous daily serving of green leafy vegetables, which inevitably complement the emotional work.  

One of my clients summed up the parallel process beautifully when she said: "I did not know whether my improved energy and positivity was the result of resolving long-held trauma or eating better - but I’m grateful for both."

Another commented: "As I lost a few pounds, I regained my old self," while another suggested: "When I really started to look after myself by eating better, I had more energy to face the dark stuff."

While it's certainly necessary to acknowledge the important role of allopathic/conventional medicine when clinically justified, I'd like to suggest Hippocrates, often considered the father of Western medicine, was spot on when he said: "Let food be thy medicine." 

In my view, his words apply equally to our mental health as to our physical condition. He offered a truly holistic approach. 

If you'd like to learn more about my approach, please feel free to get in touch with me at 96 Harley Street.  

By: Gemma Davies

About Gemma. She says of her practice: As an integrative psychotherapist, it is both my philosophy and my joy to bring resources, techniques and new learning to my clients from the complete spectrum of mind, body and spiritual schools in order to support their growth to wellness.

Photo by Sara Dubler on Unsplash