Against ‘Mental Health’
“No more awareness, please!” is the cry from one a leading UK psychiatrist every time we enter the annual Mental Health Awareness Week. He is in a minority. Nowhere has this been clearer than in the time of the pandemic. During the lockdowns imposed in so many countries, our lives have been discombobulated, our habits thrown into confusion, our news filled with images of suffering and death, our loved ones facing the prospect of a horrid and potentially fatal illness, our neighbors masked like old-time outlaws, our lives confined and constrained as never before, our futures thrown into doubt. Many of us, not least those whose lives are already tough, are anxious, sad, worried, miserable, angry, scared, exhausted, stir crazy, lonely, troubled, distressed, perturbed, apprehensive, occasionally dejected, sometimes terrified as our meager financial resources melt away before our eyes. But this language of the emotions seems not enough. What is at stake, it seems, is our mental health. The newspapers are full of stories about those experiencing mental health problems, charities and experts give us advice on how to manage our mental health, exercise gurus frame their injunctions to stretch, jump, run, and so forth, not just for the good for our locked-in bodies, but because they are good for our mental health. Awareness is all. Once we are aware that the feelings we are experiencing are mental health problems, once we can speak openly about these mental health problems to family, friends, and employers, we are en route to a solution. No stigma, no shame—who could not welcome the fact that mental health has come out of the shadows?
It is a brave psychiatrist who would be ‘against awareness’ during this pandemic. Most predict nothing less than a tsunami of mental health problems. Lockdown children are of particular concern. Did you think that kids were dragged unwillingly to school, yearning for liberation at the end of the school day, and the freedom of the holidays? Not so. 100 specialists in psychology, mental health, and neuroscience, in a letter published in The Sunday Times, predict that loneliness and isolation during school closures could permanently damage children’s mental health, and urge government ministers to release kids back to the salutary benefits of school (Roxby, 2020).
Adults too: did you think that many people might actually enjoy being spared the arduous daily ritual of the commute to and from work? Not so. Psychologists, psychiatrists, and epidemiologists are busy charting our pandemic moods; their surveys report increased anxiety and sadness during the ‘lockdown’ (Fancourt, Steptoe, and Bu, 2020; Banks and Xu, 2020). Despite findings that are ambiguous at best, authors usually conclude that “greater efforts need to be made to help individuals manage their mental health during the pandemic” (Fancourt, Steptoe, and Bu, 2020). More research is needed.
Did you think it might be distasteful to regard a global pandemic as a great opportunity for research grants? Not so. A multi-authored paper in Lancet Psychiatry calls for action from ‘mental health science’ to collect “high-quality data on the mental health effects of the pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19.” There is “an urgent need” for research funding agencies to stump up to help develop what are bizarrely termed “mechanistically driven interventions” to address “the psychological, social, and neuroscientific aspects of the pandemic” (Holmes et al., 2020).
Did you think that dynamically inspired therapists might learn from Freud’s modest claim that psychoanalysis offered only to transform hysterical misery into common unhappiness? Well, not quite. Under a headline warning that another pandemic looms, this time for our psychological health, feminist psychotherapists, trauma therapists, and grief counsellors—some of whom, we are told, are best-selling authors—predict long-term consequences, especially for those who have had past experiences of trauma: “the psychological fallout of the pandemic will be a huge and protracted challenge for an overstretched and underfunded health system” (O’Hagan, 2020).
Who could be ‘against mental health’? Who would minimize the stress encountered on a daily basis by health workers forced to practice in exhausting and dangerous conditions without protective clothing, with so many patients in peril of death? Who could doubt the strain on people in cramped apartments, juggling the demands of children, domestic responsibilities, work? Who could doubt that social isolation is sometimes hard to bear, especially for single mothers or those who are elderly or dependent? Who could fail to recognize the apprehension of front-line workers carrying on emptying bins, delivering parcels, driving taxis and buses despite the pandemic. But are they experiencing ‘mental health problems’? Are they ‘at risk’ of mental illness? Are their feelings actually ‘symptoms’ that may, if not attended to, become ‘mental disorders’? Are these experiences of anxiety, trepidation, despondency even anguish matters of ‘health’ at all? Should we think of them in the terms of the Convention on the Rights of Persons with Disabilities: psychosocial disabilities, which restrict those who experience them from full social participation? Should our guide be the World Health Organisation, which defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”? Would that not classify about 90% of the world’s population as lacking mental health? But if we decide that these are not matters of health, what about the problem of comorbidities, the intertwining of diseases such as diabetes, coronary heart disease, metabolic disorders with these very feelings of anxiety and depression, leading to calls for the treating physician to regard them as part of the same ‘syndrome’? (Barnett et al., 2010). Would it not be better to think of the distress of body and soul experienced by those forced to make their lives in the face of the consequences of structural inequality in terms of ‘social suffering’? (Kleinman, Das, and Lock, 1997).
How can it be, after half a century of researching the history of psychiatry and its institutions, of teaching about mental health and society, of living with someone with a severe and enduring mental disorder, that I do not know the answer to these questions? After three months of intensive reading about mental health during the pandemic, I am more confused than ever. I know people with psychotic depression, bipolar disorder, with diagnoses of post-traumatic stress disorder and schizophrenia. And whatever they experience, it is not what has come to be termed ‘a mental health problem.’ So, no, don’t obscure these by folding them into an all embracing narrative of mental health. Less awareness please, less transmutation of despondency, apprehension, unease, uncertainty, and the manifold ailments of being human in a profoundly unjust world into problems of mental health. Yes, I am against ‘mental health.’
References
Roxby, P. (2020). Coronavirus: Child psychologists highlight mental health risks of lockdown.’ BBC News. https://www.bbc.co.uk/news/health-53037702
Fancourt, D., A. Steptoe, and F. Bu (2020) ‘Trajectories of depression and anxiety during enforced isolation due to COVID-19: longitudinal analyses of 59,318 adults in the UK with and without diagnosed mental illness.; medRxiv: https://doi.org/10.1101/2020.06.03.20120923
Banks, J. and X. Xu. (2020) The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK. 2020, Institute for Fiscal Studies: London.
Nikolas Rose
