Let's change how we think about mental health

Seeing psychological distress as a mental health problem supports a modern cultural myth.

Charles Merrett
3 July 2015
My depression story. Credit: Youtube.

My depression story. Credit: Youtube.

Recently it has seemed like attitudes towards mental health are changing. During the UK General Election this year, for example, the seven main political parties all included mental health in their manifestos.

Each included the need for more funding for research, the better setting of standards and time-frames for access to treatment, a focus on young people, motherhood, the disabled and prisoners, as well as the need for more talking therapies. There was also talk of mental health being comparable to physical health and an emphasis on the need to tackle discrimination.

To many this might seem like progress. Attitudes are developing. So is terminology, with softer language used, and less emphasis on the term ‘mental illness’.

Even so, when psychological distress is not explicitly described as mental illness, it is still usually regarded as something different in kind from what would be considered ‘normal’ experience. It is perceived as arising from a 'disorder' or 'condition'.

Current ideas around mental disorder pay little attention to the power of human thought and its causal role in our distress. When we regard depression and anxiety as mental illnesses, we should do so with more reflection on the underlying assumptions at work: do we think about the symptoms only when they happen, or does thinking have a part to play in producing the symptoms?

An alternative approach would be to recognise thinking’s complexity, richness and especially its power to move us. When we ‘think’, we are not simply seeing the world as it is. We are imposing on it our view of what we like and dislike. what we want or fear. We are considering what we feel the world should be like, and what we hope it is not. As we think, we interpret, predict and judge.

YouTube is a good guide to how ideas about mental health play out in the community. Many people have courageously posted video accounts of their experiences. These are often moving narrations of times in the person’s life when things were difficult. From the supportive comments that many of these have received, they clearly resonate with others. These accounts are clearly useful descriptions of how it can feel to be very distressed.

However, there are aspects of the accounts that seem limited.

In these video accounts, vloggers almost always present the widely accepted view that their distress is a result of ‘depression’ and ‘anxiety’. The vloggers usually describe a difficulty in understanding their experience and a belief that there is something inherently wrong with them. Naturally, from this perspective, they become concerned with identifying what is wrong and seek diagnosis, which will help them towards seeking appropriate treatment. In this situation, the distressed person’s focus is on the feelings, symptoms and thoughts they experience.

This may all seem obvious because it is the most common way of thinking in our society, but there is another way of understanding our experience of distress and these videos provide a rich source of evidence for an alternative.

To see this evidence we need to watch the videos with fresh eyes.

Throughout the videos the bloggers give clear details on how they were thinking when they first became distressed, as well as throughout their journey. Each person is different but it is clear that when we are distressed we can become preoccupied by our situation and do lots of intense thinking.

Amongst the thoughts the bloggers describe is confusion at not being able to understand their feelings. They describe: fears of what is wrong and how bad they might become, attempts to trawl through past events to find a cause, intense reactions to specific events they suspect of being the cause, ideas about what they could do to get better, treatments and techniques that might make them feel better.

These personal descriptions demonstrate the thought processes at work that are not necessarily considered when labeling distressing experiences ‘depression’ or ‘anxiety’. These thoughts matter. They make a difference. They frame our lives.

It is also important to see the intimate relationship between the thoughts we have and the feelings and emotions we experience as a result. Our thoughts are the source of our emotions. We can think of ‘thoughts’ a bit like Trojan horses; from the outside they may appear like the gift of rationality but they trick us, take us by surprise. They are full of emotions that can make our heads spin and our stomachs churn.

When we regard thinking and emotion as separate we overlook their intimate connection. If we do not see the thinking that lies behind our feelings we are left only to focus on the emotions and their concomitant physical sensations and we fail to recognise the emotional consequences of the thinking we have engaged in as we try to make sense of our psychological distress: What is wrong with me? Am I going mad? How bad will it get? What would people think of me if they really knew what I was like? These are not neutral thoughts that don’t matter. Try thinking them with absolute conviction and you will realise the emotional power they have.

Thinking is not simply a rational process. It is an on-going, active, expressive, creative process. It is fast-moving and often restless. It is with our complex subjective, value-laden thoughts that we colour our world and animate ourselves. Since much of the time we are relatively unaware of what we are thinking, we are, in effect, the secret agents of our own experience. If we don’t pay attention to what we are thinking, we will very likely make our predicaments worse.

What the YouTubers describe are good accounts of how it can feel to be distressed. Up to a point this is very useful. However, if we listen more carefully to their accounts we find plenty of evidence of extremely powerful thoughts, like the ones described above. These are the thoughts that people are naturally led to once they perceive their distress as a mental health problem they are ‘suffering from’.

In the process they are, at the very least, intensifying their distress, making it harder for them to find practical solutions. Though this is entirely understandable, it becomes a problem when they limit their understanding when they think about their distress purely in terms of disorders and conditions. These ideas can be misleading, by focusing solely on symptoms and diagnoses and ignoring the power of thought.

When we add our voice to the established view of psychological distress as a mental health problem we support a modern cultural myth. The distinction between the ordinary psychological ups and downs of life and mental health problems rests on the belief that the latter cannot be understood in terms of normal psychological processes.

Mental health problems are seen as strange and inexplicable, at least to the layperson. This makes them seem unpredictable and frightening and, ironically, increases stigma and discrimination.

Perhaps, what we really need is not campaigns to stamp out stigma, or even necessarily new funding programmes, but new ways of understanding ourselves, based on a recognition of the powerful role our thinking plays in our experiences.

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