High profile campaigns and the drive to make mental illness the norm does little to help those genuinely suffering to deal with their issues.
It is – should you have failed to notice – Mental Health Awareness Week here in the UK. If that seems to have come around rather quickly, then it’s because there is an absolute raft of similar events – sixteen, at current count, ranging from days to months of ‘awareness’, which is the popular, rather meaningless modern term of choice. At the time of writing, only January and some of the summer months are omitted from this protocol. Though it’s hardly as though the dialogue tapers off during that time: on social media, many people are very eager to discuss their personal unhappiness on a daily basis; grifters like Matt Haig have made a lucrative living out of it, though always finding the inner strength to viciously target anyone who questions him, despite his panoply of apparently debilitating conditions. It becomes a cabal, a club, an in-group; to suggest as much is anathema, utterly heartless, but it’s true. In a time when mental illness is apparently still stigmatised and shunned, many, many people include their hard-won diagnoses (either from a doctor, or Dr Google) in their bios. People endlessly describe details of their symptoms, to the extent that it seems to be not just accepted, but eminently acceptable, even noble; mental health symptoms are ripe for sharing; other debilitating conditions seem less timely and shareable, which is strange because – I would argue – we are our bodies. Our mental states don’t exist in a vacuum, with all other component body parts getting on with it while the brain flounders.
But before I digress here, it might be useful to discuss what ‘mental health’ actually refers to, as it seems to have morphed into an almost meaningless umbrella term. The Oxford Dictionary refers to it as, ‘a person’s condition with regard to their psychological and emotional well-being’, which as a definition contains two more umbrella terms which could do with a definition, but looking past that: there is an in-built emphasis here on ‘well-being’, with the assumption that if anything impinges upon that sense of well-being, then your mental health is therefore out of kilter. And herein lies one of the biggest and silliest lies inherent in current discourse: that anything short of a sense of well-being is a deficit, even a serious issue that must be addressed. Look, no one likes feeling miserable, frustrated or angry, but these feelings are a completely normal part of being alive. We’re at risk of pathologising everything which falls short of super-duper. Whilst we are – at least in the affluent West – living in a time of comparative ease and comfort, professional, familial and romantic worries can still get to us. It doesn’t mean there’s anything wrong with us, simply that we are going through a period of difficulty, albeit which likely won’t end in us starved, murdered or outlawed, as it has millions of our ancestors. And if I sound like I’m being glib here, then to an extent I am: if you feel so low that you can make the decision to spend the day in your soft bed, watching your flatscreen TV in your plumbed, heated home on a paved street, then you are still luckier than billions of people who have both come before you, and who are sharing the earth with you now. Ah, but ‘mental illness is no respecter of status,’ goes the adage: I don’t know about you, but I’d rather be miserable in the plumbed, heated home all the same.
And as for mental illness? Another almost meaningless umbrella term, which is used with little consideration by many of those who most cling to it. In the same way as ‘nerves’ represented to the Victorians anything from a slight aversion to one’s occupation right through to catatonic states (with the term ‘nervous breakdown’ hanging on in modern language to describe an equally baffling array of things), ‘mental illness’ can take in anything from severe psychosis to not wanting to go to school to the mildest anxiety. Dislikes can become phobias, distastes can become disorders; the way society deals with anything which disrupts regular hours of operation is to make it into a condition which exists somehow outside the person, and as such not their fault, but also overshadows everything they do. Not that people typically seem to mind that process; they recognise its worth. Sociologist Pierre Bourdieu devised the idea of ‘cultural capital’, that certain assets, such as level and type of education or immersion in aspects of culture, such as the arts, enable people to enjoy certain kinds of social mobility. I would argue that for certain sections of society being conversant in mental health conditions is a new kind of cultural capital, a network of mutual acquaintance and recognition.
THE LOST GENERATION?
Covid has generated a seemingly endless run of articles and cautionary tales about the super-impact of the pandemic on mental health. And of course, many people have lost jobs and businesses, or been isolated from friends and family: no one is denying the difficulties of this for social creatures who live in a system where you need to earn money. The tack taken by the likes of the BBC, however, is to remind us endlessly that we are, in effect, sitting on a mental health disaster: when it has a few minutes of downtime at the end of its day’s reporting, the news often now elects to focus in on some small group in society who have it particularly bad. Farmers! Students! Curators! Nail technicians! Consider! Reflect! Had you not enough to do and think about in your own life, you are now given the gift of an endlessly running series of the woes of strangers, none of which you can materially help; you are simply told, and that’s that. Do with that unhappy information what you will, because tomorrow we’ll be talking to professional gardeners and what they’re going through. Raising awareness often feels just like spreading powerlessness – sound and fury, signifying nothing. And, as this timebomb – an often-used word – allegedly ticks away, we are not short of voices eager to share their stories. The people who seem most likely to be struggling are still the ones we don’t hear from, though; the suicidal are often a bridge apart from any discourse taking place about their problems; young men in particular labour under the ‘if I can’t fix it, then I’m out’ frame of mind. And where are they? Not on Twitter with this in their bios. The mental illness debate is not all things to all men, as ubiquitous as it seems to be. Perhaps that mental health umbrella and the debates surrounding it are splitting off into different camps at this stage.
That all being said, and in these interesting times when people will tell you they’re bipolar before you know their last name, are we really sitting on a timebomb? Is this really the ‘lost generation’, and is this really a mental health crisis? Not according to The Lancet, who have performed a longitudinal study on the impact of Covid-19 on mental health outcomes in the UK. Whilst their findings indicate a mean deterioration in mental health at the beginning of lockdown, as we’d expect, the study indicates ‘the mental health of most adults remained resilient or returned to pre-pandemic levels’ between April and October 2020. As for suicide, when the British Medical Journal examined studies from around the developed world, they found either no rise in cases or a slight fall. As they rightly point out, this isn’t simply dry data and every suicide at any point in history matters, but nor are we served by any misrepresentation of the risk or inflation of the numbers. In fact, given the great pains we take in other aspects of modern life not to promote suicide to the suicidal (referring to people ‘entering the water’ rather than throwing themselves in, for instance) then the almost eagerness in some quarters to talk up suicide rates is nothing short of unsettling; some treat it as a distasteful emblem of just how bad we have it which isn’t grounded in fact or reason. Maybe we can’t fully blame people for doing that. We have this notion that talking is always good; is it?
“TELL ME ABOUT YOUR MOTHER…”
Modern mental health treatment usually takes in two key areas; medication, and counselling. A great deal of emphasis is placed on the latter, a kind of systemised, queue-for-it chat which will do you good, because it just will. It really only dates back to the dawn of the 20th Century, although some enterprising earlier Victorian alienists (i.e. proto-psychiatrists) were developing more patient-focused methods of care; small praise, mind, given some of the very earliest treatment options. Freud is the father of psychoanalysis: in a nutshell, this put forward the idea that everything was about shagging and if you disagree that’s because it’s in your unconscious, and you need a psychoanalyst to get it out (at a cost). Once you’ve seen the light and understand that you did, in fact, fancy your own mother, your problems will dissipate. Again, I’m being glib, but I think it’s deserved for a man who used his suspect experiences with a wealthy subset of bored Austrians to shape an entire, largely feckless industry. A huge proportion of the West’s approach to treating mental illness still stems from a man who believed in the universality of penis envy. But aside from ideas about anuses which would probably fast-track him to a psychiatrist of his own these days, he gifted us the ‘talking cure’ motif: simply by talking, you will remove whatever blockage is impairing you, and voila.
We have never wavered from our belief in the magic of talking about our problems as a way of shifting them. The talking cure became a universal, and as demand for this fixer-upper has grown over the decades, we’ve loosened our requirements about who gets to offer it. If we can call elements of psychiatry into question, then we can certainly wonder at the growth of the counsellor; the counsellor is to the psychiatrist as the nutritionist is to the dietician. It’s become a more accessible, less-academic version of psychology, a mini-industry of its own. By way of example, daytime TV maestros Learn Direct have waived their fee for an entry-level Counselling course until next year, but even when they do start charging you, it’s a bargain at just shy of £30 a month. (Though their accompanying graphic, shown above, is a little suspect; maybe counsellors can manhandle you, where doctors cannot.) Look, I’m not saying silence is golden, and sharing ideas with people who – and this is important – are in a position to offer you good, achievable advice can obviously help, but the exponential growth of an army of strangers with clipboards doesn’t seem particularly efficacious; the argument usually goes that it would work even better, if only we had more of them. Personally, I think there is a question mark over the entire power structure and rationale. And, whilst many people are likely drawn to the industry because they sincerely want to help, there will be others who wash up there out of less abundant motives. Why wouldn’t they want to be in that position of relative power and influence?
THE CLINICAL COSH
Perhaps alongside or, more usually, instead of counselling, there is usually a programme of medication prescribed to the mentally ill. Admittedly, developments in knowledge of brain chemistry, particularly around the behaviour of serotonin, have led to a new wave of antidepressants which – even if I’m damning them with faint praise – are less invasive and problematic than previously prescribed drugs; gone are the days when you’d just throw some barbiturates at a housewife and leave her to it. But the brave new dawn of SSRIs and to a lesser extent, tricyclics has not been without issue; aside from the problems of over-prescription and overreliance, these medicines and their makers have seen controversy over dangerous side-effects. The Paxil controversy is ongoing and the same drug, which was named Seroxat in the UK, is no longer prescribed here because of its significant study-proven links to increased rates of suicide. In a world where more and more people consider themselves mentally ill rather than sad, the prescription of these medicines continues to rise; there is little follow-up, often a tacit understanding that you must stay on the medication for a long period of time (perhaps your whole lifetime) and a tendency to attribute any positives which come along to the drugs, rather than the person who has perhaps made some concrete changes in their life. This has always struck me as unfair, but then it is a real tangle, hard to unpick. Where does the medicine stop and ‘you’ begin? Does all credit for feeling better go to the medicine? What about not feeling better – for how long and how far do you trust the medication to fix you?
People certainly aren’t above abusing said medication, either. Sometimes, or hey, maybe often, the bored middle classes take it upon themselves to demand medicines they don’t require, or to abuse medicines they have procured. Last week in the Grauniad, a young woman describing the woes of being a successful ‘Influencer’ related how she went to her long-term psychiatrist (of course she had one) and got given Mirtazapine. This triggered a manic episode, although she hadn’t been diagnosed with anything like bipolar previously; even a palliative relocation to Spain didn’t fix it. Later she says, “I decided to treat myself to a whole antipsychotic to mark my birthday”. Funnily enough, this didn’t go well, because that’s not how you fucking use medication, let alone an antipsychotic. People would never tinker with heart medication the way they do psychiatric medicines, nor would doctors dole out the latter so readily.
We have developed a toxic series of norms whereby antidepressants are treated like a panacea in some regards, their issues underestimated, and their misuse and debilitating side-effects often tolerated, because anything’s better than cold, hard reality and at least it’s something. In a stretched health system, they’re often a well-meaning, if not well-thought-out attempt to provide treatment when a person is asking for help. Meanwhile, we’re still informally told that this is the worst crisis in mental health ever recorded, with ever more and more people wrongly convinced, I would argue, that how they feel needs to be treated. Surely there’s an element of contagion in being constantly confronted with these claims for the end of days, with the ‘timebomb’ analogy; surely, some voices are illegitimately drowning out others, or demanding interventions that aren’t suited to them. Our acute emphasis on self, self, self has surely propelled many people into situations that they did not need and which may even have precipitated illness, like our Influencer above. And of course, self-declarations, some dubious, are at an all-time high; when has there ever been a more amenable time? I’ve had people more or less yelling at me, ‘Actually, I have an anxiety disorder,’ because nothing screams anxiety like drawing massive attention to yourself in a public place. People aren’t above using the modern parlance as a goldmine for excuses – though God help you if you’re willing to suggest this – and the punchline for all of this is always ‘more support needed’. Every single BBC misery piece: ‘lack of support is blamed’. But what support, and how? What really works, and how are we measuring it?
I could head off into personal anecdotes about my own experiences here, but this needless, mawkish oversharing is part of what I’ve been criticising in this article. So instead, I’ll say this: the best solutions are practical ones. If a talk can cure you, then your condition isn’t so terrible, and for the vast majority of people, state of mind can and will improve without running straight for the GP or for the paid stranger’s office.
Ultimately, these awareness-raising exercises are so often largely cosmetic, self-perpetuating flummery on social media, which invite people to wallow in a powerful and influential in-group, with ‘DMs open’ and endless threads to keep people just where they are, even if this is largely done with good intentions. In fact, these regular Mental Health Events may do more harm than good; not everyone likes being constantly confronted by mental health, and it’s nonsense to think they do. In a quick-moving age of instant gratification and high levels of self-reflection, mental health debates have become all-pervasive, an ever-broadening church with a nebulous number of diagnoses and treatments with an expansive calendar. In my opinion, the best self-care takes place outside of these places, and with surprisingly little input from them.
KERI O’SHEA
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