It is important to say, before I start, that here I am absolutely not doubting the existence of severe distress, or the toll that it can take on people who are struggling and those around them. Rather I am questioning the way that we currently categorise and work with such experiences, and the role of wider culture in them (which so often gets missed).
What sparked this line of thinking, for me, was a series of adverts a few years back under the Time to Change campaign about mental health, which was put together by the Institute of Psychiatry, Mind, and several other mental health organisations, with the aim of ending mental health discrimination. The adverts featured celebrities such as Stephen Fry and Ruby Wax speaking openly about their own experiences of distress, and many quoted the '1 in 4' statistic. For example, the poster with Stephen Fry on it said: '1 in 4 people, like me, have a mental health problem. Many more people have a problem with that.' Ruby Wax's said '1 in 5 people have dandruff. 1 in 4 people have a mental health problem. I’ve had both.'
Clearly the statistic was intended to raise awareness of the commonality of mental health problems and to decrease the stigma of those experiencing them. However, I feared that it was in danger of doing quite the opposite.
The 1 in 4 figure is problematic anyway as it is not clear where the figure actually comes from. Of the few studies which have found something like this figure, some have been measuring families rather than individuals, mental health has been measured in various different ways, and it is unclear whether we are talking about, for example, 1 in 4 people at some point during their life, or 1 in 4 people in the last year, or 1 in 4 people at any given point in time.
However, for me, the bigger problem is the potential impact of the figure. 1 in 4 suggests that 75% of the population do not experience mental health problems. That is a substantial majority. The danger is that this situates people with mental health problems as 'them' (compared to 'us' who don't have any such problems). As we know very well in psychology, the creation of any kind of 'us and them' situation increases, rather than decreases, likelihood of discrimination.
Most of us will experience some form of abuse in childhood (if we include 'bullying' by peers, which I think we definitely should); all of us will experience life events such as bereavement of a loved one in adulthood which tend to result in a period of high distress; not to mention the existential givens of life which we all struggle with. Given this, is 'ill or well' a useful model at all?
The common dichotomous understanding which I see amongst counselling clients, friends, and students alike when they are talking about their own – and other's - experiences of distress and suffering is as follows:
I'm ill – I need help – it's not my fault
I'm not ill – I don't get help – it is my fault
People commonly feel, deeply and certainly, that these are the only two possible places to be: ill or not ill, and that the other aspects presented here follow from that. Not only is this a splitting up of the unsplittable biopsychosocial which I mentioned in the previous post. It also suggests that there are only two options: biology or choice (social doesn't even come into it). Mental health problems are seen as an individual – frequently physiological - problem which requires treatment (commonly drugs, sometimes also therapy) to fix. However, if there is no evidence of such an individual problem (if no diagnostic label fits, for example, or if there is suspicion that they are not suffering enough) then the person cannot be ill and therefore any struggles must be their own fault.
This way of understandings things is problematic on all levels. It prevents many people with distress from admitting it because, if they do admit it, they will have to give up control, take on a victim/ill identity, and open themselves up to stigma and discrimination. Those who embrace diagnosis may be disempowered (due to the sense that they can't help themselves and must require expert help). They may feel that they have to take certain treatments (often drugs) because of the common idea that mental health problems are biologically caused and must be biologically treated, despite the question marks which still exist over whether, and how, such drugs work and whether they are the most appropriate way of addressing such issues in all cases (not to mention the vested interest of 'big pharma' in perpetuating this particular understanding). There is no room here for sociocultural explanations or for more complex involvement of personal agency.
Also, many people oscillate between the two positions as neither side really captures the complexities of human distress. This means that those who don't identify as having a mental health problem are haunted by the fear that perhaps there is something terribly wrong with them which needs fixing (and hiding this fear, and any signs that they might be struggling, puts them under immense pressure). Those who do embrace a label such as 'depression' are often haunted by a huge sense of guilt that maybe they are not really ill and maybe this is all their fault and they are totally to blame (which massively exacerbates any suffering they were already experiencing).
This puts people in a horrendous double-bind when it comes to speaking about their own, inevitable, distress and struggles in life. If we openly disclose as 'depressed', for example, (as many people did on the recent 'world mental health day') we run the risk of reinforcing this ill/well split such that those who do not embrace such an identity feel their struggles going unacknowledged and the pain of that invisibility. If we keep quiet about our distress, or resist such labels, then we can equally reinforce the ill/well split as we are read as 'well' by those around us.
We need to move to more biopsychosocial model of distress. We need to recognise that distress – in its various forms - happens for complex multiplicity of reasons, and that we can have a personal role in exacerbating and ameliorating it, but that acknowledging such a role does not mean that we are totally 'to blame' or 'at fault'. We need to understand that we can all access support rather than it being something only for a certain few, and that different things work for different people at different times. We need to challenge either/or illness/wellness dichotomies and to consider other possible models and metaphors for distress.
Next postThe next post in the sequence is here.
Bad science?More on antidepressants and big pharma from Ben Goldacre here and here.
New commentYour words regarding the suspicion that they are not suffering enough then the person cannot be ill, had me laughing out loud (not with mirth!) that's exactly how it is. And this point links with the one about the giving of drugs. If the person is able to stuff down their feelings, and particularly if they can speak for themselves, oh heavens forbid the person withwthe mental illness dare also be intelligent, then they are viewed as imposters, they must be lying, or attention-seeking, or feeling sorry for themselves. BUT even these are only barbed labels to cover the real reason the medical person is angry. The true reason is the power trip. They need the one with the problem to give them the control, they need to see raw helpless anguish or anger, so they can then give out the pills. The drugs are used to make people shut up, be malleable and amenable. This is not done to cure but to control. Which leads on to the question of why people dm't want to give up control. It is not always about taking on of an ill identity. It can be about the reason of 'power over', the abuse of power, the loss of freedom, the loss of the right to choose, the loss of the right to feel your feelings. I don't usually say I suffer from depression, I usually say I suffer from oppression, surprising how many people grin and nod and relate to that one lol. We need to be allowed to feel our feelings, all of them, and do so freed from all their false labellings of good and bad. We need to be able to feel and speak our truth without being medicated into smiley outsides volcanic insides, or zombies. There is the real world nature. Then there is the overlay of the man-made world. Now there is the man-made virtual world. Each a step away further from reality. I think new models for wellbeing, need as an essential, the foundation of, not man's world, but the real world of nature.
New commentI like 'I suffer from oppression' very much Wren - nice one! Thanks so much for engaging with this - great to hear that it is resonating with someone.
New commentI like reading your posts, they have 'meat', something for the reader to get their teeth into. Also they are 'active', the subject matter you speak of is real life, to bring about real, and beneficial, change, not merely an intellectual exerice.