I CAN’T remember the first time I heard the term ‘mental health problems’. It certainly wasn’t around during my very young years in the 80s. I don’t remember it being in popular use during my 90s high school life either. When I was reflecting on this the only example that came to mind was speculation that cleaning-obsessed Monica from Friends had ‘OCD’, obsessive compulsive disorder, something most people didn’t really know the meaning of at the time.
I was diagnosed at 13 with a mental illness, anorexia nervosa. It was probably the wrong diagnosis then and I’ve had many different ones since. It’s now settled on clinical anxiety, OCD, PTSD and, overarching all these, mixed states bipolar. It’s a lot. I could be seen as living proof that diagnostic boxes are often unhelpful. Yet they do guide treatment and above all provide confirmation that there is clinical need – i.e. you are ill.
People don’t appear to like the term ‘mental illness’ so much any more. I was honoured to have my ‘lockdown story’ read out on the excellent Daily Telegraph ‘Planet Normal’ podcast. My email was read out verbatim except one detail – the words ‘mental illness’ were changed to ‘mental health problems’. Perhaps for many ‘mental illness’ evokes images of asylums, straitjackets and screaming patients. It’s far more palatable to have endless discussions and campaigns, fronted by glowing celebs, about the importance of sharing problems. Meet up for coffee and cake with a friend! Do some meditation, go for a walk, do crafts and mindful activities! Indeed mindfulness has become a massively lucrative industry. Slap the mindful or wellbeing label on anything from podcasts to puzzles, herbal tea and even pizza and your sales will rocket. Of course relaxing mindful activities are enjoyable and undoubtedly helpful for many people. But there is clearly commercial and PR interest at play in the spread of ‘mental health’ and ‘wellbeing’ into all aspects of life. Indeed the problem is that these terms have become interchangeable and somewhere down the line ‘mental illness’ has become lost.
Life has made me pretty unshockable but even I was shocked to see the blurring of mental illness with going through tough times on the charity Mind’s website. In the section for 11-18-year-olds there are vaguely defined sections on ‘your feelings’, ‘your mental health, ‘your wellbeing’ and ‘mental health problems’.
Unfortunately the implied message here could be that if you’re finding things hard you’ve very likely got a mental disorder. Clearly emotional upheaval can worsen or even precipitate mental ill health. However I, and indeed many experts in psychiatry and psychology, would maintain that there is no inexorable link. It is common for mental illness to appear for no clear reason. Someone could on paper have a great, happy life and nonetheless be hit like a truck by depression or another mental illness. On the other hand someone could go through terrible experiences without suffering mental illness. Genetics, innate neurological wiring, plays a large role.
The muddling of language risks creating paranoia and even fear in those who are going through emotional upheaval and life trials rather than illness. On the Mind website we read that the following are all terms that are synonymous with ‘mental health problems’:
poor emotional health
How can we possibly conflate ‘mental illness’ with ‘emotional difficulties’? Around the time I was first diagnosed with a mental illness I suffered emotional difficulties due to Robbie leaving Take That. I’m being serious! For weeks it made me burst into tears and I felt like I was grieving. But it didn’t cause or even affect my mental illness one iota. Of course this is a trivial example but Mind lists many more serious problems on its website:
confusion about who you are, your sexuality or beliefs
pressure from yourself or others
feeling lonely or like nobody understands
being bullied or abused
worrying about what’s happening in the world, like things you hear about in the news
Show me a teenager who hasn’t experienced all of those, except the extremely serious issues of bullying and abuse. Life throws many emotional challenges at us that are, for want of a better word, normal. Such problems are certainly not anything to do with being ill and most importantly do not require clinical intervention.
Thinking about this post I was struggling to clarify my whirlwind thoughts about the increasingly nebulous nature of mental health discourse. A very clear point is the far too common and inappropriate use of clinical intervention. The slogan ‘1 in 4 people will suffer from mental health issues’ is used a lot in campaigns. On the ‘Time to Change’ website it states: ‘1 in 6 people report experiencing a common mental health problem (like anxiety and depression) in any given week.’
This number of people can’t possibly be described as ‘ill’ and in need of medical help. ‘Anxiety’ and ‘depression’ are serious clinical conditions, which vary in severity but nevertheless need to be given clinical support. However these words also have a more fluid, common, everyday usage and therein lies the problem. We’re all guilty of saying we’re ‘depressed’ when we’re just sad and ‘anxiety’ is even more disconnected from the illness of the same name.
I am not doubting that most of the 1 in 4 or 6 people struggling with their feelings and life need some type of support. But I would suggest that for the vast majority this support should come from non-clinical sources. Sadly these sources have been depleted over the years. Families are no longer as connected as they were. Many people don’t know their neighbours. Faith is no longer relevant for many. These issues have very much come to light in the last two years of Covid lockdowns.
Perhaps that is why currently the primary port of call for emotional support is often the GP. It may surprise some to hear that I deeply regret visiting my GP aged 13 with the problems I had then. Yes, I was ill but, contrary to what one might think, early clinical intervention is not always the best thing as it can be too aggressive and therefore actually create more problems.
Then there are the issues of medication and the use of precious clinical resource. There is definitely widespread overprescribing of psychiatric medication such as antidepressants. These medications can save lives. I am reliant on psychiatric medication. But they can also create a whole host of problems including nasty side effects and dependency. The use of these powerful drugs should only be in cases where the benefit clearly outweighs any harms and other avenues have been pursued first. However it’s an easy ‘thing to do’ for a GP who knows the waiting lists for talking therapies are long. I would argue that the single biggest reason the mentally ill cannot get sufficient care is the inappropriate use of resources for people who are not ill. A main driver of this is our common daily discourse around mental health.
Recently there was an article in the Telegraph by Celia Walden defending Joanna Lumley’s comments on what she called ‘the mental health bandwagon’. I couldn’t agree with both women more. There are ever more who use having ‘mental health problems’ for personal gain. Celebrities are the obvious culprits but sadly I have also encountered ordinary people, especially youngsters, almost thinking having a ‘mental health problem’ makes them more interesting. Dare I say, it’s almost become fashionable – the opposite of stigma.
Yet the real stigma around real, nasty, ‘crazy’, debilitating illness remains. Rethink Mental Illness, a superb charity providing support for and education about mental illness sums up the situation eloquently: ‘. . . people severely affected by mental illness still need to see meaningful change across all aspects of everyday life.’
The conversation around mental health problems or mental ill health is complex and difficult. Despite having a mental illness myself I struggle with it. I’m also often captured by popular terminology and a prisoner of the available words. That can probably even be seen in this post! However I passionately believe that this is a vital discussion, because there is a fundamental difference between mental illness and life problems. In broadening the mental health conversation we’ve actually lost what most needs to be talked about.