"We've normalized drinking coffee with lorazepam, why don't you take both?"

Marta Carmona (Madrid, 38 years old) acknowledges that in her profession, psychiatry, they have a problem developing collective responses.

"The look we have to try to understand is infinitely broader than the look we have to act and intervene," she laments.

In the current context of a global conversation about the (poor) state of mental health, Carmona publishes a book,

(Captain Swing), which aims to broaden the "horizon beyond the attempt to improve myself or my patient in particular, but to improve this neighbourhood, this city, this environment of coexistence".

He has written it in four hands with Javier Padilla, a family doctor and current deputy for Más Madrid in the Madrid assembly, to land an idea: structures are needed to protect the vulnerable before discomfort, crisis or suffering arise. .

Carmona, who belongs to the board of directors of the Spanish Association of Neuropsychiatry and the Madrid Association of Mental Health, does not renounce the individual response in therapy, as when she consults, "but by God, that is not the only way of answer".

Q.

A panel of experts has just recommended for the first time to the US government that it carry out routine screenings for signs of anxiety among the population.

A.

This comes from the pathological and totally biological perspective of trying to understand anxiety as prostate cancer: a phenomenon with a natural history of disease, which has a beginning and an end, and if I catch it right at the beginning I have an effective treatment which solves it.

Nothing in mental health works like that.

Generally, we speak of disorders, whose beginning and end are much more diffuse, and which are much more integrated into the subject's identity.

There are still slightly better policies to try to reduce the anxiety that comes, for example, from job insecurity: no matter how much you detect it, if it doesn't improve, you need a response to a conflict that is not resolved.

It's like when Amazon announced the AmaZen booths [relaxation for their employees]...

Q.

It seemed like a parody of

.

R.

We know that we are generating unbearable living conditions for many people and we are going to plug it however we can, with any solution.

As if in times of slavery you say: we are going to try to detect depression among the slaves and we are going to give them antidepressants and psychotherapy.

Or you can abolish slavery, right?

Which probably improves mental health quite a bit.

We live in an ultra-individualistic historical moment and then the solution for any problem is psychotherapy for all

P.

The cliché says that the poor are happier.

A.

That is a shocking narrative.

Psychic suffering can appear in any social class.

Christina Onassis has always been used as an example: in the end she commits suicide and her suicide is as dramatic as that of any other person.

But the harder your life circumstances are, the harder you have to deal with those things that are hurting you and on top of that you have less ability to choose or change your life circumstances.

Wealth is not a guarantee of good mental health, but of course poverty is a guarantee of getting stuck much more and having it much harder.

That speech that tries to deny the part of the social conditions is terrible.

P.

And what discourse must be vindicated?

R.

We live in an ultra-individualistic historical moment and then the solution to any problem is psychotherapy for everyone.

There are many people who need psychotherapy and cannot access it, this is a truth like a temple.

But in the end that's the individualistic framework again.

A neoliberal context is never going to say no to that, because there is also a huge business niche.

Lots of people can benefit from therapy, but if we channel any kind of suffering through that individual response, it probably isn't going to any root cause.

At all times you have to pay attention to those threads that you have to pull, that are more hidden, those that are not going to have anyone to put a loudspeaker on them to make a profit.

You can give slaves antidepressants and psychotherapy or you can abolish slavery

Q.

Is mental health the new talk-of-what-time-ago?

R.

At the moment when it becomes the topic of fashionable conversation and there are a thousand reports and a thousand

of celebrities talking about it, there is visibility and a tendency to frivolize it.

It also happens that more attention is paid, generally, to those who least need it: there is a lot of talk about milder and more adaptive things, but about the serious mental disorder that continues to have a brutal stigma, very little has been said about it in this boom.

The most damaged people do not appear, but I am one of those who thinks that in the long run it will come in handy that at least we are all talking about this.

Q.

But are the appropriate debates taking place?

R.

It is good that it is normalized that people talk about their anxiety.

But not if people have anxiety because their body is screaming no, this is not, this is not tolerable, and what we do is say that this is how to live.

We have normalized drinking coffee with lorazepam, which everyone knows is absurd.

It is absurd to take a stimulant and an anxiolytic at the same time.

But it is done because it has been normalized, because life is like that, life goes on.

You drink a coffee and get active and you take an anxiolytic and you fall asleep.

There are people who have tricks: I take one before, then another after.

And why don't you take off both?

I can't take both things off because I can't, they tell you in the consultation.

It is a somewhat dangerous narrative to answer it with resilience: very resilient slaves with a very good tolerance for frustration

Q.

Because of the feeling of taking control?

R.

Of course, this for one thing and this for another.

I tell you that your liver doesn't really care what you take it for.

But I find it very significant of the times.

I have a day to day that makes no sense, my body screams no, but I do it to endure my workday, my three hours a day on public transport, my only seeing my friends once a month.

In the consultation we try to make patients understand that anxiety is a signal that your body gives you, there is something that is not going well.

With these routines, we are suggesting that people lower the volume of the alarm.

The fire alarm in your building goes off and you just intervene to stop it from going off, instead of looking to see if it's burning.

Q.

How to prevent collectively before problems arise?

R.

That's the part that mental health professionals have a hard time seeing.

I hit my teeth if it is understood that the solutions that can affect you the most in your life may not be those that specifically affect you, but something that has previously protected you.

Anything that makes your life a little easier, whether you like it or not, will help the rest.

That the working hours are not so strenuous, that there is not a situation of job insecurity, or also all those mental health problems that come from what happens within families, the thousand intra-family relationships that can be harmful.

That there are alternatives when a child is having a hard time, whether it's because of a school issue, or because of a family issue, that they know what's going on, have someone to turn to and that cycle can be broken a little.

Or that people who face enormous loneliness in certain phases of their lives have communities available to turn to... That all those things that can cause suffering have people worrying about them and taking action.

The best example is

in schools.

You can understand it as an individual problem for all children, for all adolescents, you can understand it as a macro-level problem.

But in the end, the cabbages have to have their protocols, they have to put them into operation... There you can see very well what the intermediate intervention is: this exists and the cabbages have to respond in some way.

We need this to be done with all the other elements that can harm you throughout your life, in the family, relational or work.

Leaving vulnerable people lying around, that institutions do not support them, can have consequences for mental health

P.

Are there tolerable discomforts?

R.

That normalization is what I see as tricky.

Tolerance to frustration must be developed, we cannot generate a society of tremendously immature people, who do not know how to accept a no or a defeat.

And it is true that individual responsibility is essential for good mental health.

But I give the example of gambling and pathological gambling: the individual responsibility of the person with pathological gambling is of course there, but if you focus everything on that, then there is nothing wrong with filling any neighborhood with bookmakers, especially the most impoverished, nor for setting up bookmakers in schools.

With the malaise in general, I think this happens: it cannot be that you appeal to that capacity so that people swallow cars and carts.

It is very important to tolerate frustration, so nothing,

everyone to do a 12-hour workday.

It's a somewhat dangerous narrative, because the problem is when you have to respond to everything with resilience: very resilient slaves with a very good tolerance for frustration.

Q.

Is worrying about mental health leftist?

R.

In mental health, you can understand any specific case in one way or another if you broaden the focus sufficiently.

The case of Simone Biles, for example.

You can say that the Olympics are very stressful and anyone has the right to bang, so to speak.

Or that the gymnasts, with anxiety, lose the mapping and cannot do the acrobatics.

Or you can zoom in a bit and see that the American gymnasts were coming off a horrific lawsuit against their federation, which had been systematically covering up a horrific sexual abuse case and had been sold out.

If the entire planet is going to start talking about Biles's mental health in particular, we can see that leaving vulnerable people lying around, and not being supported by institutions, can have mental health consequences.

In the end, psychic suffering is a reaction to things that happen to us.

I'm not going to say that talking about mental health is left-wing, because it shouldn't be that way, but worrying about the situation in which the most vulnerable people live, asking how we care for those who suffer the most, well, it does have a political bias .

When someone comes to the consultation telling their anxiety, their things, well, you dedicate yourself to asking questions each time with a slightly broader view, from the exact symptom to who is the person in front of you, what has happened in life and what has happened to him so that he is now like this.

And you end up finding, generally, that this suffering comes from somewhere, it doesn't come from the air, it doesn't just happen.

When you find a systematic pattern,

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