It’s impossible not to notice that a lot of people, particularly young people, are suffering from anxiety and/or depression, which gives rise to the argument that we are in the midst of an epidemic of some sort of psychological epidemic, so much so that primary care physicians are now admonished to screen patients under the age of 65. Are we?
One argument proffered is that this isn’t a crisis of mental health at all, but an entirely proper reaction to what’s happening in our world.
But are we really in a mental health crisis? A crisis that affects mental health is not the same thing as a crisis of mental health. To be sure, symptoms of crisis abound. But in order to come up with effective solutions, we first have to ask: a crisis of what?
Throw in a ten-dollar word by sociologists, “reification,” and you can argue that there is no medical problem, but a political one.
Reification swaps out a political problem for a scientific or technical one; it’s how, for example, the effects of unregulated tech oligopolies become “social media addiction,” how climate catastrophe caused by corporate greed becomes a “heat wave” — and, by the way, how the effect of struggles between labor and corporations combines with high energy prices to become “inflation.” Examples are not scarce.
As much as this is the sort of explanation many would like, as it takes the burden off them and puts it on external factors so that the fault lies not with the sufferers, but with their stars. But as much as we may prefer an explanation that says we’re okay, are we?
Ordinarily, the word “health” implies an absence of illness. That is no longer how the term “mental health” gets used. The idea of mental illness, or mental disorder — both terms that have been subjected to their own intractable debates — has come to be supplanted by a broader umbrella notion, “mental health,” which somehow, confusingly, gets used to refer to states of both wellness and distress.
Some awareness campaigners have even adopted the slogan “We all have mental health,” which seems on the face of it to be a stigma-busting, solidarity-building mantra. On closer examination, however, it manages a double exclusion. It fails to actually name any mental health problems — those about which we ought to be raising awareness — and it also makes a claim that is sadly untrue; there are many people who, at least some of the time, do not have mental health.
In our zeal to eliminate the stigma associated with mental health, a worthy cause that’s prevented many from seeking the treatment they need to function, to enjoy life, to not fall down a dark hole to a place from which they can never return, has mental illness been “reimagined” into a normal state, even a laudable state, to be shared in exchange for the validation of “likes” and thoughts and prayers?
The term “mental health” is a euphemism, and euphemisms are what we use when we want to obscure something. This language — in contrast to “mental illness” — encourages us to focus on the regulation of more or less transient states, and on the maintenance of something we supposedly all have.
Everyone feels anxious and/or depressed from time to time, whether for good reasons or not. But are these “transient states” the same as “mental illness,” or are they fostered by an industry to solve a serious problem, mental illness, by conflating it with ordinary feelings that come and go?
This shift also cuts in another direction. An emphasis on health and equilibrium, with accompanying “advice” and “techniques” for self-regulation, has resulted in the term “mental health” undergoing a kind of mission creep: from providing increased awareness of specific difficulties to offering a broad set of prescriptions about how we should live.
If the fix for our mental health is dependent on voting for one party and against another, or criminalizing guns, or funding climate change initiatives, or taking puberty blockers, then the solution is very different than getting diagnosed by a competent doctor and being treated with appropriate medication and maybe even therapy, if one can find a competent therapist.
The shift toward prioritizing mental health might be benign if it were only one way of reframing the question of what our priorities should be. But it comes with the imprimatur of clinical authority. As a result, therapists increasingly stray into a broader ethical arena while appearing to remain within their own zones of expertise.
Is there a middle ground between the old way of denigrating people because of mental illness and turning mental illness into a badge of honor? Is there a middle ground between trying to help people overcome their anxiety and depression rather than guru therapists manipulating patients into adoption of their politics?
Mental health professionals are understandably interested in mental health — but we need to remain interested in how people lead lives that are good, happy or meaningful without ever spending much time with clinicians. When we move away from a focus on psychological problems and toward “mental health” more broadly, clinicians stumble into terrain that extends beyond our expertise.
Lacking the education, expertise or experience to have any meaningful view of how to address what appears to be a mental health crisis, I can’t discern the best way forward. But there is a strong argument to be made that, yet again, we’re doing everything possible to obscure a real and serious problem behind a wall of unduly passionate beliefs that isn’t making lives any better. Will we become a nation constrained to choose between perpetual therapy or a smack by Cher to tell us to snap out of it? Are therapists the right people to answer the question, for if all you have is a hammer, etc.?