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. There was lots of discussion and education about bullying in school and amongst young people. But none of that related struggling with life to mental ill health. 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! However I was diagnosed with a mental illness aged 13 - anorexia nervosa. It was probably the wrong diagnosis even back 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 anymore. I was honoured to have my ‘lockdown story’ read out on the excellent Daily Telegraph ‘Planet Normal‘ podcast. My email was read out with such compassion and verbatim except one detail – the words mental illness were changed to ‘mental health problems’. Perhaps for many ‘mental illness’ evokes images of historic asylums, straight jackets and screaming patients having to be constantly sedated. But you don’t have to go back into history to find harrowing inpatient treatment in hospitals and clinics for the mentally ill. I’ve been in a few over the years and know only too well that the grim reality does not match depictions you might see on TV. It’s not all people talking about their problems on cosy sofas and doing glass painting. I have yet to see a realistic depiction even in the ‘gritty’ soaps. Perhaps it’s too uncomfortable. 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 mediation, 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. As I’m working on this article an advert is playing on Classic FM for ex Love Island star Dr Alex George’s new show on ‘Pastural Music and Wellbeing’. 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. Furthermore, the last thing I need when I’m spending 3 hours to prepare/eat breakfast and get ready to go out is a beaming celebrity on This Morning telling me how exercise and baking have helped their anxiety. That’s not a judgement on them and their problems, which I obviously know nothing about. But it is a judgment on the conflation of all manner of life struggles with actual illness.
Life has made me pretty unshockable but even I was shocked to see the blurring of mental illness with going through tough times on charity Mind’s website. In the section for 11-18 year olds there are slightly confusing and vaguely defined sections on ‘your feelings’, ‘your mental health, ‘your wellbeing’ and ‘mental health problems.’ Indeed the charity’s website statement of raisin d’etre is,
We're Mind. We understand mental health and wellbeing. We're here for you if you're finding things hard. We help everyone understand mental health problems, so no one has to feel alone.’
Unfortunately the implied message here could be that if you’re finding things hard you’ve very likely got a mental disorder. Of course it is just common sense that there is a wide spectrum of what could be called ‘mental ill health’ and also a vast spectrum of ‘emotional distress or discomfort.’ 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 may be surprising but it is nonetheless common for mental illness to appear for no clear environmental reason. In other words someone could on paper have a great, happy life and nonetheless be hit like a truck by depression or another mental illness. (I feel compelled to say here what is painfully obvious to many - depression is not being very sad). On the other hand someone could go through terrible experiences without suffering mental illness. Of course conditions like PTSD and sometimes OCD do arise directly from traumatic experiences. Furthermore it must also be said that suicide can be prompted purely by traumatic circumstances and is not always related to mental illness. However genetics, inate neurological wiring, plays a large role.
It is of course still vital to give people support whatever the nature of their suffering. However the muddling of language risks actually 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
overwhelmed
mental illness
mental ill-health
emotional difficulties’.
I found this distressing and I can’t believe I’m alone in that. 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 spontaneously burst into tears and I felt like I was grieving. But it didn’t cause or even impact my mental illness one iota. Of course this is a fairly 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 and across society. On the ‘Time to Change’ website it states that
‘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 can clearly vary in severity but nevertheless need to be given clinical support. However these words also have a more fluid, common, everyday usage and therin 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. Mind’s definition of ‘mental health problems’ is as follows:
‘A mental health problem is when the way you're thinking, feeling or acting becomes difficult for you to cope with.’
I am not doubting that most of the 1 in 4/6 people struggling with to cope with their feelings and life need some type of support. But I would suggest that for the vast majority support should come from non clinical sources such as family and various places in their communities. Sadly these sources have been depleted over the years as we have become ever more disconnected and social isolation has increased. Even families are no longer as connected as they were, especially extended families. Many people don’t even know their neighbours. These issues have very much come to light in the last two years of Covid lockdowns. There was hope that community spirit would be re-evoked but I share concerns that the pandemic has only further increased social disconnection. Over the years social services and community youth and indeed pensioner support initiatives have struggled with resources and growing socio-cultural problems. It’s also no longer the default setting to seek help from the church and faith has lost its relevance for many. My vicar Mum often feels like some of the best community work she does is reaching out to those who are bereaved. They are not ill but they definitely need compassionate support.
People lead busy and even frantic lives so time for others is often a rare commodity. Perhaps that is also why currently the primary port of call for emotional support is often the GP. After listing problems like exam stress, a new job, problems at home, in school or with relationships, the Mind website gives good advice to talk to someone you trust about your feelings. Yet then it’s straight to
‘If you're worried about the way you're feeling or you're going through a difficult time, it might help to speak to your doctor.’
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 and can actually create more problems. I would have certainly have needed clinical support for my mental illness at some point but at that early stage it was too agresssive and indeed traumatising. At least the PTSD part of my illness could have been avoided. The potential for harm is even greater when someone isn’t actually ill but just struggling. I fear society is creating health paranoia and worry. We are surrounded by advice to examine our feelings, get in touch with them and analyse . . . Am I ok? Could this emotion/these thoughts be a problem? Could I be ill? Overthinking is the dark heart of many problems. It’s not a positive habit to get into. Crazy as it sounds, (pun intended), sometimes the best advice is not to overthink but to let thoughts wash over you and distract yourself. Of course I know only too well that this strategy has severe limits with actual mental illness. My own illness has painfully shown me that over the last nearly 27 years. However when a mental or emotional problem is not an illness but just, well a problem, then distraction is often preferable to becoming too focused on the negative thoughts. This is where the discussion about mindfulness and general wellbeing has its place and much of it is common sense.
But it’s not just ‘overthinking’ that’s the problem but 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, my sister’s among them. I too 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 often 6 months to a year. The reason for the ridiculous waiting times is that too many people are asking for medical therapeutic care. Many would argue this is because too many really need it. But I fear and also have some personal reason to believe that a huge chunk of these struggling people could get support in other ways. This also stretches beyond primary care therapy. Periodically scandals come to light of people with autism being inappropriately hospitalised or even sectioned into clinics for mental illness they do not have. The absence of community support for non neurotypical people has also got a role to play in the overburdening of mental health services. However, perhaps controversially, I would argue that the single biggest reason the mentally ill can not get sufficient care is the inappropriate use of healthcare resources for people who are not ill. A main driver of this is our common daily discourse around mental health.
Recently there was an excellent 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 ladies more. Alongside those genuinely concerned about their mental health, whether for good reason or not, there are ever more who actually use apparently having ‘mental health problems’ for personal gain. Celia Walden quite rightly calls this ‘shameful and often cynical exploitation.’ It’s extremely uncomfortable for me to judge anyone’s mental health and their public discussion of it. The incendiary impact of Piers Morgan questioning Meghan Markle’s mental struggles and claims to have been suicidal show that society also feels uneasy about this area. Mind was incredibly condemnatory of Piers and insisted that no one must ever question someone’s claim to have any type of mental health issue. But I passionately believe that we must face up to the fact that people have and are exploiting this aspect of health. Celebrities are the obvious culprits but sadly I have also encountered so called 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.
Another excellent article, Romy. I very much agree x
I couldn't agree with this more. As mother of a 13 year old daughter, who is forever mentioning a different friend who "has anxiety", I seem to spend my life reminding her that it's possible to FEEL anxious (about perfectly understandable things!) and not "have anxiety". It saddens me that this generation seem to be getting the message that these feelings aren't normal, but instead mean they have a 'condition' of some sort. The self-fulfilling prophecy of that seems all too obvious.