In the wake of World Mental Health Day and Theresa May’s appointment of a suicide prevention minister, this might seem like the least propitious time to make a case against mental health awareness, even if both of the events mentioned have been criticized as tokenistic rather than consequential. Evidently, awareness raising about mental health has never been more widespread, yet it is still often argued there is a taboo against talking about mental illness.
Newspaper columns often showcase frenzied discussions of everything from the student suicide epidemic to the worrying rise in antidepressant use, whilst personal stories of mental illness are shared more often and more openly by the day. Social media provides other ways of raising awareness, from hashtags to viral campaigns. For example, here is a detailed summary of the ways in which memes are used to promote mental health awareness. But this catch-all phrase awareness has been coming under increasing scrutiny. Some commentators argue that we have an over-prescription problem, symptomatic of a moral panic fuelled by too many doctors pandering to patient fears, too much self-diagnosis and too little effective research into the utility of antidepressant use. We must continue to ask ourselves if raising awareness is still proactive or meaningful. The push for awareness can be a counterproductive way of approaching the mental health crisis.
Those who focus on awareness often approach the problem by presenting inflated statistics. Although student suicide rates have been parsed as an epidemic, the statistical risk has remained steady in proportion to total student population and is actually lower than that of the general population. But perhaps it’s only the problem of suicide that is being sensationalized—while there has been a very real increase in other related mental health problems? The issue, however, is what we choose to call problems. Many issues have become medicalized, no matter how far the symptoms are from meeting the threshold for diagnosis. This facilitates incorrect self-diagnoses. Awareness raising can encourage hypersensitivity and panic, bringing an increasing number of experiences, which are part and parcel of the stress of tackling quotidian obstacles, under the widening umbrella of mental illness. At universities, this has led to infantilizing remedies, often tied to safe space culture. Victimhood abounds, interpersonal upset is rebranded in the language of microaggressions and trigger warnings, and everyone must be wary of what they say in case those listening are especially sensitive to the sound. This has inspired ten-step guides and stilted infomercials dictating unnatural social behaviors, which we are encouraged to adopt before we can even have a normal chat with someone experiencing mental health problems.
This pathologizing of and protection from discomfort is nowhere more prevalent than at universities, as Jonathan Haidt and Greg Lukianoff have recently highlighted. Worryingly, UK higher education minister Sam Gyimah has recently called for academics to make the wellbeing of their students their top priority, above their duty to educate. Amidst a looming student mental health crisis, he argues that universities must provide emotional support for students during their academic studies, in order to “fulfill their purpose.” The number of first year students seeking mental health support has reportedly grown fivefold in the past decade, whilst the rate of dropouts due to mental health problems has trebled. The BBC this week reported that over the past five years there has been a 50% increase in students seeking mental health support. Sadly, the panaceas of pet therapy and self-care classes seem insufficient to ease the strain that has been placed on student mental health services. When universities must be seen to be doing everything to tackle the purported epidemic, it is no surprise that they come up with nannying responses, such as closing libraries late at night to encourage better sleeping habits. I have no issue with people just trying to reduce stress, but to frame these as solutions—as responsible ways for universities to tackle the mental health problems of their students—is ridiculous.
Criticism of all too simplistic awareness raising, and the medicalization of everyday problems it encourages, is nothing new. Vice has questioned this trope, through articles such as “Stop Confusing Your Nerves With Having Anxiety.” Areo has featured a report from a clinician who treats young people incapable of escaping a self-constructed narrative about the intractable depths of their mental ill health. Spectator Life has addressed rising anti-anxiety prescriptions for children, suggesting that mental health education has enfeebled kids who are now too aware to benefit from an ignorance is bliss mentality. A recent Guardian article argues that “people claiming they have serious conditions when they don’t just exacerbates negative stereotypes,” even though another article in the same paper rightly points out that “genuine awareness raising—thoughtful, responsible testimonies from people living with mental illness or disability—is invaluable.” I categorize these sorts of testimonies as mental health openness.
The Case for Mental Health Openness
Calm and open discussions of a person’s experiences—anecdotes about seeing their GPs, discussions of SSRI dosages or details about treatment plans—are the easiest way to normalize mental health problems and make people aware of what others are going through. This process might even help the sort of people who are trapped in a climate of intense navel-gazing individualism—those who overthink and catastrophize their problems and internalize a narrative of being trapped by their mental illness—become aware that their issues are manageable, not medical.
Isabel Hardman has penned masterful, thoughtful, touching testimonies in the Spectator which have been a comfort to me during my own rougher spells. Dealing with topics such as grief, anorexia and anxiety, honest personal stories, written by those who have overcome or are undergoing a darker period in their lives, can be heartening and helpful. Tellingly, there seems to be no real gender disparity in the authors of these articles: even traditionally stoic males are opening up. The idea that we still need to raise awareness about mental health is belied by the fact that many of those telling their stories are stereotyped as the very people who are most at risk of bottling things up.
I may not be personally aware of the extent of the taboo around discussion of mental health, since I am a student, socializing in circles in which sympathy for sufferers abounds. Most of my peers are socially aware and emotionally intelligent. However, the perception that it’s hard to talk about mental health doesn’t hold as much water as it once did. There is a marked difference between a subject being taboo and just being difficult to talk about. The topic of mental health isn’t ring-fenced. But the opportunities to talk about it are few, and our ability to do so is plagued by embarrassment and timidity—something no amount of awareness could ever remedy.
You should receive support from friends and family whether you are going through a tough time or are genuinely mentally unwell. Yet many people feel they will receive more emotional support if they have been properly diagnosed, are undergoing counseling, seeking therapy or taking SSRIs. When an unhappy person undertakes a period of soul searching, they are unlikely to emerge from it concluding that they are simply suffering through life’s normal ups and downs.
Whilst medication may well be unnecessary for some—there is evidence to suggest that SSRIs are being overprescribed and that their side effects may be no better than the symptoms they are designed to remedy—we should show no less compassion towards those who are experiencing comparable symptoms, but who would benefit from other forms of treatment. The tranquilizing relief medication brings can often stop sufferers from tackling the underlying issues.
Commentators often equate mental health problems with physical ailments (insisting rightly that we should be no less embarrassed to talk about mental than about physical disease). The flip side of this, however, is that only when the afflicted person is treating her mental ailments like physical problems, i.e. with pills, are we willing to validate her suffering. This might create a perverse pressure to prove that you really are mentally unwell rather than just stressed out. Falling back on the sure-fire proof that you must be truly ill because you’re on medication is understandable. But perhaps we should look for other ways to distinguish those really struggling to cope from those who are having a tough but manageable time of it? We have created a new sort of stigma in reverse—the stigma of not being mentally ill enough—albeit a stigma that might well be restricted to millennials and generation Z, who are considered at higher risk of mental health issues.
Treating mental health as a physical problem is an unintended by-product of the awareness raising designed to normalize the problem and convey both the seriousness and the treatability of the symptoms. A friend of mine who has long suffered from the truly stigmatized problem of alcoholism— of which the mental symptoms are a precursor and an accompaniment to the physical ones—knows this first hand. After months of unsuccessfully trying to get help with his addiction, which was causing him acute mental suffering, he was sent straight to the front of the queue for treatment only when his face became visibly jaundiced, i.e. when the physical symptoms became too extreme to ignore. Treat it like a physical ailment works well in theory, but less so in practice: mental ill health is simply nothing like having a broken leg. In my experience, it is not until you become a physical threat to yourself that clinicians start to take notice. This might reflect the strain on mental health services—they have to prioritize somehow and this is a crude and effective form of triage. But it will take a huge cultural shift before we worry about the mental as much as we do the physical.
Before suggesting counseling or cognitive behavioral therapy to counter stress and anxiety, doctors often fall back on the treat it like you would a physical problem mantra and recommend medication. Innumerable self-help tips are also available for those who are struggling. Self-help literature—ranging from memoirs by Google employees on how to hijack your productivity to advice from Navy Seals on how to turn struggle into progress—is a huge industry. And, though proven to be ineffective, it is worth $10 billion per year. There are more and more anti-anxiety products marketed at the general public by the day: stress balls have been superseded by fidget spinners, adult coloring books and weighted blankets. Imagine how someone who feels that they are mentally unwell might be affected by this, caught in the growing trends of self-improvement, and using commercialized anti-anxiety products. How does someone who feels that he is genuinely mentally ill, but who is not taking SSRIs, reconcile himself to the fact that the methods he is using to treat his illness are not dissimilar from those a healthy individual might by seeking from the teachings in The Power of Now?
We need to be careful how we frame problems of stress and keep a sense of proportion, acknowledging the range of possible experiences and not trivializing real suffering in our noble attempts to improve everyone’s lot. As Ken McLaughlin has argued, “We first need to take on the cultural zeitgeist that cultivates psychological vulnerability and seeks to medicalize all the material and existential problems of human existence.”
Between Callousness and Condescension
Critics argue that over-prescription of SSRIs is extremely detrimental. Instead of encouraging psychic resilience and explaining that feeling stress is normal sometimes, we are creating a crisis by being too afraid to tell those in need of a dose of stoicism precisely what they need to hear. Some have argued that this is traceable to the rise of the over-sensitive snowflake generations (millenials and generation Z), who venerate identity and would never risk offending anyone on the basis of their self-perceived identity, even if doing so would be beneficial because it would prompt much needed self-reflection. Dispelling deeply held personal narratives about the fragility of someone’s mental state is a thankless task, even if it is the best way to help them in the longer term.
One of the most outspoken advocates of human resilience is Brendan O’Neill. In “You Are Not Mentally Ill,” he argues:
We shouldn’t ditch the stiff upper lip; we should rehabilitate it, and encourage the young in particular to exercise it. Having a stiff upper lip doesn’t mean being an arrogant muppet who thinks nothing in life ever touches him—it simply means believing that you have the moral and mental wherewithal to cope with things, even when they get difficult.
As ever, there is a grain of truth in O’Neill’s contrarianism. My personal position is analogous to that of Christopher Hitchens on climate change. Even if the climate change denialists are right, the fact that our existence is tied to this one planet should force us to exercise caution and not risk irreparably damaging it. Similarly, we each have only one mind and one body—shouldn’t we err on the side of caution? It seems both unsympathetic and irresponsible to simply urge someone to exercise a bit more self-discipline if they are feeling gloomy or stressed. As Iona Italia points out, an unprecedented number of students really are struggling with mental illness. We should do everything we can to help those in pain—without necessarily categorizing their problems as fully-fledged mental health issues, but also without being so callous that all we do is recommend a dose of stoicism.
Another, much subtler and more ubiquitous, misguided response to those with mental health problems is that of conflating depression with low self-esteem. J. K. Rowling’s tweet to Andrew Tate, a man accused of claiming that depression is merely a failure of will, strayed close to this in my opinion. Rowling told Tate, “Some of the most gifted, successful and gorgeous people I know suffer/have suffered with depression. You are not alone. Have a hug.” This might have been sincere, but ultimately it sounds both patronizing and hollow. Depression is much more complex than this. I found Tate’s tweets, insensitive as they are, more motivating than J. K. Rowling’s. At least, Tate’s tweets—like a cruder and more callous version of Jordan Peterson’s 12 Rules For Life—encourage taking responsibility for yourself.
Perhaps others may find Rowling’s sentiments more comforting than I do: there is more than one way of being obtuse when it comes to helping those with mental health issues. Between what we should recognize as these two extremes—between life-hacking tips that masquerade as encouragement on the one hand, and condescending compliments and fake deference on the other—there are approaches that can help. Jungian analyst Lisa Marchiano provides an apt summary of this middle ground. Marchiano argues that we should help sufferers “understand themselves as resilient, rather than infirm and frail. We ought to help people imagine larger, richer, more complex stories for themselves, rather than simplistic narratives of illness and victimhood.” Though Marchiano addresses this advice to people with minor, non-medical anxiety issues, helping people imagine a richer future for themselves, and helping them take steps towards that future, is an approach applicable to mental health problems in general.
Some argue that awareness raising simply helps us to tackle anxiety and depression—but it can stray into romanticization of mental illness. It is true that more serious and uncommon mental health issues are still poorly understood and negatively stereotyped. Encouraging everyone to be open about the real nature of their problems and the effects they have on them— whether these effects are serious, diagnosable, treatable, commonplace, well or poorly understood—should be imperative for everyone seriously interested in tackling the mental health crisis.
We should be similarly open minded in our responses. There is often a stigma attached to telling someone that their problems (whilst deserving of empathy and concern) don’t constitute an illness. But it benefits everyone when we can speak openly about these topics, without self-conscious hedging or timidity about how we are likely to be perceived. When someone talks openly about his mental health problems, we should offer understanding, respectful, engaged listening—but not mollycoddle or patronize. Sufferers are not merely part of an alarming statistic. We should be wary of confirming faulty narratives or parroting empty platitudes drawn from unserious wellbeing campaigns.