Sunday, 30 June 2013

Mental Health without Mental Illness?

The Sunday Times  boasts two agony aunts: Mrs. Mills and Sally Brampton . Aunt Sally deals with the serious stuff and has a side-bar that recommends books, products and websites she thinks might help readers. In today's issue there's a recommendation for a book: Jonathan Haidt's "The Happiness Hypothesis". This might be a fine book and I may even read it but the wording of  the recommendation itself bothers me. Brampton writes that the book is "part of the positive psychology movement (which emphasises mental health rather than mental illness)".

Which Emphasises Mental Health Rather Than Mental Illness.
This got me thinking; is it possible to emphasise mental health without mental illness? Those who advocate more thinking about mental health, more talking about mental health, more funding of mental health and that we all need to look after our mental health would dispute that they are raising the incidence of mental illness. They claim that the more we look after our mental health, the less likely we are to succumb to mental illness.  I would argue that the opposite is true.

This is because you cannot promote one side of the coin without the other. The definition of mental health espoused by the positive psychologists is broad and its breadth necessitates a corresponding broadening of mental illness. Take this definition of mental health from the, ahem, well-known yoof website
“Mental health is about more than being free of mental illness such as depression, bipolar disorder, schizophrenia etc. It is also about having a positive sense of wellbeing. Positive mental health allows us to enjoy life’s pleasures, believe in our own abilities, cope with the normal stresses of life, work/study productively and enjoy socialising.”
Is this telling a young person that if he or she doubts their own abilities, finds life hard to cope with, find study difficult or look forward to the school disco only to find it the inner circle of Hell, that they have a mental health problem? The problem with this definition of mental health is that it can be summed up in one word: perfection.
Because if you're a young person who enjoys socialising, studies productively, believes in your own abilities, appreciates life's pleasures and has developed adult coping skills while still a teenager, then you're just about perfect.
This is the mental health that we are promoting to young people, that the ads on television urge us to mind, that SPHE and tries to inculcate and that Minister Quinn wants to put at the heart of the new Junior Cert.  Schools are adorned with positive thinking slogans. Motivational speakers are brought in to address Transition Year students, often on the theme of Positive Mental Health.  My local Mental Health Organistion no longer satisfy themselves wth providing support to psychiatric patients and their families. They now run an annual Mental Health Fair, attended by teens from the entire province. Past speakers include Patrick Holford. You can read more about his work here

Promoting Inadequacy
I believe that promoting mental health as not just the absence of mental illness but as a state of psychological perfection is leading to the rise of mental illness. Not actual, real mental illness but rather Mental Illness Lite, or mental health problems as described by another website, this time aimed at a younger audience than SpunOut. This website is

 A mental health problem occurs when someone's thoughts or feelings are troubling them, to the extent of affecting their day to day activities or relationships. They may not necessarily have a mental illness, but could need help to get them through a difficult time. A mental health problem that isn't sorted out could lead to someone developing a mental illness.

A mental illness is a more serious or long-lasting problem, which can be diagnosed by a doctor or mental health professional. It may require medical treatment as well as support. There are many different types, just as there are different forms of physical ill health. Examples include schizophrenia and clinical depression.”

Needing help to get through a crisis does not mean having a mental health problem. It means being human. These campaigns are dangerous not only for the effect they have on unhappy young people who are encouraged to self-diagnose and seek medical help for non-medical problems, but also for the effect they have of lowering compassion and empathy in the population at large. Categorising some-one else's difficulty as a health problem might lead to an increase in sympathy but it also leads to a categorising of the person affected as the Other.  We would be far better off cultivating the idea of Common Humanity, as defined by Dr Kristin Neff
 " Common humanity recognises that suffering and feelings of personal inadequacy are part of the shared human experience - something we all go through rather than something that happens to "me" alone."
Mental health advocates try to get around this by arguing that all of are vulnerable to mental health problems, that we all need to take care of our mental health but this not true. Most of us do not carry genes for disorders like bipolar, the majority of people will never experience psychosis or debilitating depression.

I have written here mostly about young people, not just because I work with them, but because my own experiences with the mental illness services began when I was sixteen. I was a vulnerable teenager, full of unrecognised anger at those around me, full of  what David Grey calls "the yearning inside to swim with the tide and taste it" but I wasn't as atypical as I feared. And I can see now, looking back, that what would have helped me was compassion and acceptance and reassurance. Instead began a ten year slide that started slowly, with counselling, and developed over time to anti-anxiety drugs, to anti-depressants and anti-psychotics, to self-harm, to failed bids to end my life, to locked wards and social exclusion.

I think now of myself as I sat in the GP's surgery for the first time. I didn't enjoy socialising. I struggled to reach my potential in school. I found it hard to cope with  living at home after all  my siblings had left. I doubted my own abilities. But my mental health? My mental health was fine.


1 comment:

  1. "what would have helped me was compassion and acceptance and reassurance" a phrase to sellotape onto my desk


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