A “Mental Health” Epidemic or A “Mental Illness” Crisis?

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.?


9 thoughts on “A “Mental Health” Epidemic or A “Mental Illness” Crisis?

  1. Paleo

    The author lost me at “climate catastrophe caused by corporate greed” and “effect of struggles between labor and corporations combines with high energy prices to become “inflation””.

    Their brain is so addled by politics that their understanding of what is actually happening, much less the cause and effect, is beyond ridiculous. Renders everything to come not worth paying attention to.

    And overall the politically obsessed believe the majority of us to be obsessed like them, when in reality we aren’t.

  2. Elpey P.

    I woke up with Mornin’ Joe and Mika shinin’ in
    I Zoomed with HR about microagressions and sin
    I posted a TikTok shouting “All TERFs must die”
    I tweeted my pronouns at a fascist sky
    I just dropped in to see what mental health my mental health was in

  3. Bryan Burroughs

    The more I read of that piece, the more brain cells I lost. And I think we can all agree I don’t have very many to spare.

  4. PK

    Depression (as shorthand for mental illnesses in general) isn’t shameful or valorous. It’s a fucking disease that is too often fatal. Of course some bad actors will prey on the sick and try to politicize their pain and suffering. That says nothing of the illness or the treatment. And who is out there sentencing depressed people to “perpetual therapy”? The point is to not need therapy.

    Of course depressed people will externalize their feelings of despair. It’s often easier than dealing with the much more difficult issues that are closer to home. A therapist who feeds into delusions or who simply agrees with that kind of displacement isn’t therapizing.

    I’ll put the soapbox away once depression is treated like a physical ailment. No blame, no doubt, no telling people to just suck it up, no accusing people of using depression as an excuse. Rather, care, concern, and treatment to help them overcome a very real and debilitating disease. Not so that they will be happy, but so that they aren’t depressed anymore.

    Your word salad doesn’t say what it is you’re after. It sounds like you’re mocking people trying to feel better, trying to function. Some will get shit treatment. It isn’t their fault. They’re fucking sick and not thinking straight. And what do you have against therapists anyway?

    1. Elpey P.

      “Your word salad doesn’t say what it is you’re after.”

      SG: “Is there a middle ground…?” (x2)

      I mean our culture is basically a Superfund site at this point. It’s not even really about the patients, causally speaking on a collective scale. And even the good therapists are fighting a tidal wave of toxic messaging from institutions.

      1. SHG Post author

        There’s only so many times I can say the same thing using small words.

        And dear PK’s reaction demonstrates why this problem is only getting worse, as we can’t talk about it without people losing their shit.

  5. rxc

    It’s difficult to get a news organization to stop generating “crises”, when their entire business model depends on creating more and more anxiety in the populace.

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