John Humphrys - Mental Health : an Abused Idea?

November 29, 2021, 8:59 AM GMT+0

Changes in the way we use language are often a sure sign of changes in the way we think about the world. Consider how much effort campaigning groups put into trying to control the words we use to talk about homosexuality, say, or racial groups, or what pronouns we should deploy with regard to different sexes. The aim is to change the way we think by changing the way we talk. The phrase ‘mental health’ is the latest example. Go back only a few decades and you’d be hard put to find anyone using it outside the circle of professionals dealing with mental illness. Now it is ubiquitous. Even schoolchildren refer to their mental health when they’re asked how they are. But are we now using the term too loosely? And are there dangers in it?

To many people the change has not come soon enough. Our previous failure to utter the phrase, they argue, simply reflected the fact that we were turning a blind eye to an obvious source of human suffering and unhappiness. It’s not so long ago that we simply divided people into just two categories. There were the mad, the insane, the lunatics (best locked away in institutions) on one hand, and the rest of us on the other. It’s true that over the last century or so we have started to apply a bit more discrimination in dealing with people who were palpably mentally unwell. Now we draw distinctions between different categories of mental illness which have little in common with each other, such as depression, schizophrenia, autism, and what we now call bipolar disorder. We used to call it manic depression. Nonetheless, the argument goes, we have been slow really to shake off the notion that on one side there were the mentally ill - no matter how many categories we divided them into - and on the other side there were the rest of us.

For a long time the idea that all of us might be prone to varying degrees of mental ailment, just as we are all vulnerable to varying degrees of physical ailment, scarcely existed. Indeed the mental and the physical were thought of as two wholly distinct, even wholly independent, aspects of our being. It’s the breakdown of that dichotomy, the realisation that our bodies and our minds interact with each other, that has led us to talk of mental health just as we talk of physical health. We are now aware that there is such a thing as psychosomatic illness – illness that manifests itself in physical form but whose cause may well be mental. We realise too that just as the body can take only so much physical stress before something gives – the heart, our lungs, our limbs – so our minds can take only so much mental stress. Put too much mental stress on ourselves and we suffer what even previous generations recognised as a ‘mental breakdown’.

You might argue that the adoption of the phrase ‘mental health’ is a step to be welcomed. There are now ways we can ‘treat’ those who do not fall into the acknowledged major categories of mental illness but who feel that what’s going on in their minds is stopping them from functioning as well as they feel they could. There are the talking therapies, developed since Freud and Jung first started investigating this whole area of human experience. And there are the more straight-forwardly ‘practical’ approaches, such as cognitive behavioural therapy or CBT. A dozen or so sessions with a specialist practitioner can help them think differently about life, about their relationships with other people and so on. It might help them change their routines: taking exercise; eating a better diet; going to bed earlier. And of course there may be pills that could help too.

Viewed from this perspective our newfound readiness to talk about mental health is wholly liberating and opens up the opportunity to reduce human suffering and unhappiness. Why, then, might anyone want to question whether it’s a good thing?

The first reason can be summarised succinctly: it’s that it risks medicalising human experience. Living is, after all, essentially a subjective business. It’s something we experience and that experience is uniquely individual to each of us. The experience is a bit like being on a rollercoaster to which we each, individually, have to accommodate ourselves as best we can. We experience joy and sorrow, heavy moods and light moods, feeling high and feeling low and we negotiate our way through it all.

The risk in interpreting all this subjective experience in terms of ‘mental health’ is that we start to objectify what is primarily, and essentially, subjective: it tempts us to ask whether the fact that we might be feeling sad, in low spirits or whatever, is because we’ve got a ‘mental health issue’. Life turns from being the rich and not always easy subjective experience of what we ‘are’ into the arms-length, objective questioning about what we may have ‘got’. It risks turning us into the passive bystanders of our own lives: we’ve ‘got’ something so we must turn to others for professional help.

There’s another risk with this. It may become all too easy to identify the ‘good’ moods with being healthy and the ‘bad’ moods with having mental health ‘issues’. Yet a life in which only ‘good’ moods are experienced is surely a far less rich life than one in which all subjective experience is accepted as what living life to the full means.

This approach to our subjective experience can be especially pernicious when it’s applied to children. The whole business of growing up involves the intense subjective experience of becoming aware that life is a roller-coaster of emotions and learning how to hold on tight. It’s through that experience and through learning how to hold on tight that children build character and learn what personal responsibility is. To encourage children to see all that through the prism of mental health issues is to give them a free pass. It’s nothing to do with them that they’re feeling this stuff and it’s not up to them to learn how to navigate it because they’ve got a mental health ‘issue’. It’s for the adults to sort it out. For children, talk of mental health is indistinguishable from simply asking ‘have I got something mentally wrong with me?’ Indeed more widely in usage the phrase ‘mental health’ seems to be rapidly turning into a synonym for ‘mental illness’.

To talk of the risk of medicalising ordinary human experience through the use of the phrase ‘mental health’ is not to deny that there are both adults and children who are indeed mentally ill and who could benefit from professional help. The point is that to use the phrase as freely and ubiquitously as we seem to be doing risks encouraging people who do not have mental health ‘issues’ into thinking that they do.

But there is a further worry. It’s that we may make false assumptions about what threatens mental health and also about how to treat it. Our casual talk of ‘stress’ is a case in point. ‘Stress’ has become a boo-word in our public conversation. It is assumed that more stress is bad for people and less stress is good. But surely it’s not as simple as that. The Greeks had it right: ‘nothing in excess’ is the way to live a healthy life. But the subtlety of the point is that in this phrase the word ‘nothing’ works both ways: we should aim to avoid excess not just through ‘too much’ but also through ‘too little’. Too little stress can lead to mentally unhealthy lives (see those who inherit too much money and don’t know what to do with their lives) just as too much stress can. In this it is exactly equivalent to physical stress – too little leaves the body weaker than it would be if subject to more physical stress.

And are we sure we know what contributes to ‘mental health’? The Atom Bank, one of Britain’s biggest digital banks, has announced that it is going to reduce its working week from five days to four without loss of pay. It was doing this, it said, ‘to support improved employee mental and physical wellbeing’. Well, good for them in avoiding the phrase ‘mental health’. But why should it be assumed that working less is good for mental wellbeing? Some people derive their mental wellbeing from working. I happen to be one of them). And, more widely, there is the most enormous

assumption made in that now standard phrase ‘work-life balance’. It’s that work and life are somehow opposed to each other and need balancing, rather than that work is part of life and that ‘balance’ isn’t the issue at all. That’s not to deny that many people would benefit from working less, spending more time with their kids and going for long walks in the autumn sunshine. But generally the unexamined assumption is that less work equals improved mental health. Really? Always?

Finally there is an altogether more sinister factor to take into account in questioning whether we should be so free in our talk of ‘mental health’. It’s that there are powerful vested interests involved. I refer, of course, to the mighty drug companies in all this. To create a market in drugs to treat ‘mental health issues’ is to create dependency, addiction and potentially vast profits. Many people only dimly aware of the opioid epidemic in the United States assume that it has been caused by the addiction that can follow from the recreational use of illegal drugs. Much of it may well have been. But a great deal of it has been caused by lifelong dependency on perfectly legal drugs prescribed to treat mental health issues. The increased prescription of such drugs to children ought to make us all alarmed.

There has been a staggering increase in the number of people being prescribed anti-depressants in England today. Well over seven million. More terrifying still, about a quarter of a million of them are children between the ages of five and sixteen.

Can it really be possible that life is so much more difficult for a child today than it was a generation ago? So difficult that the only answer is to embark on the nightmare journey that may lead to drugs dependency?

So what should we make of our increasingly free use of the phrase ‘mental health’? Is it an overdue liberation for people who have hitherto been suffering unheard and unhelped? Or does it risk turning our ordinary experiences of life into a form of illness, leaving us to watch our own lives passively from the sidelines while others ‘treat’ us? Or is it a bit of both – in which case how should we strive to get the benefits without the costs?

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